"*" indicates required fields This field is hidden when viewing the formName First Last This field is hidden when viewing the formEmail This field is hidden when viewing the formService Choiceselect optionmarketingcoachingmarketing and coachingThis field is hidden when viewing the formWhat are the top three areas would you like to improve in your dental practice?Help us understand the size of your practice.How many doctors are in your practice?How many locations do you have?Help us understand your current vs. desired case load.Monthly Hygiene Cases*Current vs. Desired (use both ends of the slider to indicate current vs. desired cases)Monthly Minor Dental Cases (1-3 teeth)*Current vs. Desired (use both ends of the slider to indicate current vs. desired cases)Monthly Major Dental Cases (4+ teeth, whole mouth)*Current vs. Desired (use both ends of the slider to indicate current vs. desired cases) Tell us about your marketing.What types of marketing are you currently using for patient acquisition?*select all that apply Website Social Media Online Ad Campaigns Ongoing SEO Online Scheduling/Chat Content Marketing Radio Advertising or Billboards Print or Direct Mail Campaigns SMS/Text Messaging Website URL:*Are you satisified with your current website?* Yes No What is your current monthly marketing spend for all of the items you selected?* $750 or Less $751 - $1500 $1501 - $2500 $2501 - $3500 $3501 - $4500 $4501 - $5500 $5501 - $7500 $7501 - $9999 $10000 or more Give us some background on you.Has your team worked with a Dental Practice Coaching Company before?* Yes No How would you describe your experience?* It was great but lacked breadth of experience to help us as we grew. It was useful but we didn't see the return on investment we were looking for. It was an overall bad experience and made me and my team skeptical of the value of coaching. It was useful but not tailored to our needs enough. Too generic and not enough hands on support. None of these describe my experience. Help us get to know your team.Teamwork*rate your teamwork from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerribleScheduling*rate the effectiveness of your scheduling from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerribleReferrals and Reviews*rate your effectiveness at getting referrals and reviews from patients from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerrible Help us understand your patient experience.Communication with Patients*rate your patient communication from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerribleNew Patient Experience*rate your new patient experience from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerribleCase Acceptance*rate your practice's case acceptance rate from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerrible Help us understand your hygiene department.Hygiene Performance*how well is your Hygiene department performing from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerribleHygiene Retention*rate your hygiene retention from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerrible Help us understand your practice better.Collections*how happy are you with your collections from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerribleOverhead Control*rate your control of overhead expenses from 1 to 5 starsExcellentPretty goodNeutralNot so greatTerrible Help us understand how your team deals with change.How Does Your Team Handle Change?Select the option that best describes your team. We have our systems and we don't like to change. We have had a lot of change and are experiencing change fatigue. We are cautious about change but willing to change if we see a reason to. We are very open to change and like to try new things. Help us understand the learning style of your team.How do you like to learn? We are very comfortable learning virtually and interacting with online learning resources. We need at least some in person guidance but are ok with follow up training being virtual and we are ok with using online learning resources. Virtual and online learning are a barrier for my team and we require face to face guidance and learning in order to get real value. Mobile Phone*Preferred Method of ContactWe never share your information with a third party and will only use your contact information to reach out about services you have expressed an interest in.Text MessageEmailA Phone CallWhat Else Would you Like to Share About Your Needs?