Practice Analysis Worksheet
LET US HELP YOU BUILD YOUR DREAM PRACTICE!
Please complete the following Doctor Questionnaire and you will receive a free practice analysis via email.
Name:
Phone Number:
Email (required):
Website (if applicable):
How were you referred to Cutting Edge Chiropractic Consultants, LLC?:
Office Address:
Office square footage:
Can you expand your facility?
Office Hours:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Type of practice?
Solo
Multi-DC
DC/PT
DC/MD
DC/MD/PT
I am an Associate DC
Is your billing in office or outside service?
Inside office
Outside office
Are your office/soap notes electronic/paperless?
Yes
No
Describe your primary concern:
What do you feel is blocking your practice growth?
Explain your treatment approach/technique:
What kind of patient do you want to attract?
Have you worked with a management group in the past?
If so, which one(s)?
Office Statistics:
Average monthly patient visits
(Total visits in one year divided by 12):
Average monthly new patients
(Total new patients in one year divided by 12):
Average monthly patient updates
(Total patient updates in one year divided by 12):
Note: An update is a patient that has not been in the office for at least 6 months.
Average monthly charges
(Total charges in one year divided by 12):
Average monthly collections:
(Total collections in one year divided by 12):
