In order to become better acquainted with your practice, it is important
for me to have
some idea about the business portion of it. Below is a survey of specific
pieces of
information that will be helpful in creating a clearer picture of your practice
for me. If
you do not have the exact number, make the most accurate estimate you can.
If this is
also not possible, leave the category blank. Once this survey is complete,
please return it
to the PERSPECTIVES
address above.
________ Years of practice's existence ________ Years of private practice (doctor)
________ Number of operatories ________ Number if hours worked/week
________ Number if Chairside Assistants ________ Number of Dental Hygienists
________ Number of Front Office personnel ________ Number of new patients/month
________ Hours/month-- staff meetings ________ Patient visits/day
___________________________ Last 12 months' production (in dollars)
___________________________ Last 12 months' collections (in dollars)
___________________________ Total overhead expenses (in dollars)
___________________________ Type of Retirement Plan (if any)
________ % overhead/staff salaries ________ % overhead/dental supplies
________ % overhead/continuing education ________ % overhead/office
supplies
©PSILENT PRODUCTIONS, 1998