(To be filled out by owner of practice)

In order to begin the process of creating your ideal practice, it is critical to determine the
areas in need of attention. It is impossible for anyone other than YOU to determine this
for YOUR practice. Below you will find a list of eight areas I consider vital to the
establishment of a thriving, healthy practice. They are listed twice by intention. Please
carefully read the instructions and complete this form. Once it has been returned to me, it
will help me in determining the direction of my efforts towards moving your practice
forward.

List 1-- How Well Are You Doing?
 

One a 1-10 scale, rate the status of these eight areas of your practice. (1= non-existent,
10= absolutely ideal, needs no work). In determining your rating, please be as objective
as possible and as a rule of thumb consider how easily and thoroughly you could present
a clear, specific and complete response to questions I might pose about each area.
 

_____  Communications skills (with patients, co-workers and vendors)
_____  Conditions of employment (clear and specific guidelines for employees)
_____  Employee benefit package (employees' complete remuneration)
_____  Mission Statement of the practice (a group-generated process)
_____  Office systems (schedule, financial policy, budget, cash-flow, expenses)
_____  Team building (group process around the role of all employees)
_____  Technical skills (abilities and materials to complete procedures)
_____  Values-driven practice (the core values that make the practice what it is)
 
 

List 2-- What is your area of focus?

In considering all the aspects that will create a successful practice, where do you sense
that you need to place the main emphasis? You have already rated your own practice in
terms of how well you are doing. That may give you some idea about parts of it that need
more attention. However, there is probably also a part of you that intutitively knows
where you would welcome input. Please consider the same eight areas and prioritize
them from 1-8, with #1 being your first interest and #8 being the lowest.
 

_____  Communications skills (with patients, co-workers and vendors)
_____  Conditions of employment (clear and specific guidelines for employees)
_____  Employee benefit package (employees' complete remuneration)
_____  Mission Statement of the practice (a group-generated process)
_____  Office systems (schedule, financial policy, budget, cash-flow, expenses)
_____  Team building (group process around the role of all employees)
_____  Technical skills (abilities and materials to complete procedures)
_____  Values-driven practice (the core values that make the practice what it is)
 

Once you are satisfied that you have completed this form as accurately as possible, return
it to the PSILENT PRODUCTIONS address above. I will review your information and we will then
mutually decide how to proceed with moving your practice toward the next level.
 

©PSILENT PRODUCTIONS, 1998