Owner’s Questionnaire Owner’s Questionnaire Bryant Consultants likes to see the practice through the owner’s eyes and understand the current status of the business. Bryant Consultants vision is to greatly impact the lives of the dental team and their patients by delivering information and counsel that is going beyond conventional boundaries. Striving to achieve excellence in the dental practice by increasing the level of service and communication provided, while improving the bottom line. The commitment to continuous development, collaboration and advancement is what distinguishes Bryant Consultants in the dental community. Please complete the questionnaire with your personal observations. Bryant Consultants likes to see the practice through the owner’s eyes and understand the current status of the business.Name* First Last Email* Personal Email AddressAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Office Phone NumberPhone*Cell Phone NumberWhat communication style do you personally prefer?* Text Email Office Phone Cell Phone Video Calls Website*What are your office hours?*Years in business*Remaining years you anticipate practicing*Do you have a transition plan in place?* Yes No Do you have associate(s) and partners?* single associate partner past associate or partner multiple associates partners single doctor practice Do you have all contracts, buy/sell agreements and wills in place for your business?*YesNoDo you have a written budget in place?*YesNoAre your employee records current and compliant?*YesNoDo you have a current employee policy manual in place?*YesNoIs your policy manual enforced?*YesNoAre you current and compliant with OSHA standards?*YesNoYour business vision*How would you describe your business model?Fee for service onlyDominate FFS and select PPODominate PPOOtherNumber of active patients*Active patients are described as "Seen within the last 18 months)New patients*Average number of new patients each monthHow all do you market your business?*Please elaboratePrevious years net collections*What is your collection goal for this year?*Are you on track with your collections?*YesNoDo you track numbers and discuss them with your team? If yes, please elaborate*We are interested in knowing how much you involve your team in the success and struggles of the business.Current number of team members*Team member descriptions*Please share with Bryant Consultants each team members name, current position, years of service, personality style, DISC profile (if taken) and some strengths and weaknesses. the team is the key to making your vision a realityWhat do you feel motivates your team to do above and beyond their duties in your office?*Do you have an incentive systems in your business?*What practice management software do you currently use?*What digital x-ray system do you use?*Do you use digital photography in your business?* Yes No Do you currently have morning huddles?* Yes No Elaborate on your morning huddle process.*How often do you have team meetings?* Monthly Biweekly Weekly Quarterly None Please tell me about your current recare (recall) system.*How is treatment followed up on after a patient leaves your practice?*What do you feel your greatest strengths are in your business?*What specific areas in your practice would you like to see improve? Try to list them in the order of importance.*What is the last C.E. that you attended with your team?*What is the last C.E. that you attended?*Have you ever used a dental consultant or coach before?*YesNoThird ChoiceBryant Consultants success in based on your goals being accomplished at the highest level. Provided that Bryant Consultants meets your expectations we ask that you share your experience with another dentist. Upon completion and review of the information Bryant Consultants will send out contract and dates for "Jump Start' training visit. Thank you. This iframe contains the logic required to handle Ajax powered Gravity Forms.
