ExecTech Client - Spouse Questionnaire
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Name
*
First Name
Last Name
Position
*
Practice Name
*
Email
*
example@example.com
Cell Phone (Optional)
Please enter a valid phone number.
1. What are your current personal feelings about the practice?
2. Are you directly involved in the practice? If so, what do you do?
3. If you do not work in the office, any reason why not?
4. If you worked at the office in the past, what did you do and why did you stop?
5. Are you aware of anything or anyone outside your spouse's practice that is hurting the practice?
6. What do you feel needs to change with your spouse's practice?
7. What about your spouse, if anything, do you feel needs to change?
8. Are there any family problems that could be making it difficult for your spouse to practice? If so, please describe:
9. How does the practice affect the family life?
10. Do you work outside the home? If so, what do you do?
11. How long have you and your spouse been together?
12. What are the names and ages of your children?
13. What are your goals for your family for the next 12 months?
14. What are your goals for your family for the next 5 years?
15. What are your goals for your family for the next 10 years and beyond?
16. If everything went right at your spouse's practice, please describe how would things be different a year from now?
17. When would you like to take your next vacation with your spouse?
18. Do you have any questions regarding ExecTech?
19. If ExecTech and your spouse could quickly make three changes in the practice, what would you want those changes to be?
20. Any other information about yourself or your spouse that may be relevant?
Thank you for your answers!
If you have not yet met, we hope to do so very soon.
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