Practice Evolution Program

Practice Health Mini-Check Up

Please take a few minutes to complete this simple practice diagnostic tool.

I'll study your answers and see what challenges you are facing in your practice and what monsters are hiding under your adjusting table or in your office closet that you may not even be aware of! We'll have a great chat on the phone and I'll give you some suggestions and advice you can implement right away. We'll simply de-monster your practice!!

This will really help you in understanding the Program and how you will benefit from it.

Your Personal Information

Doctor:
Office Phone:
Home Phone:
Cell:
Fax:
E-Mail:
My Mission Is:

Your Practice Information

Avg New Patients:(Per Month)
Avg Patient Visits:(Per Week)
My percentage of children is:
< 5%
5-10
10-20
20-30
30-40
40 >
Explain Your Fees:Why are they the way they are?

Your Goals

How many patients/week would you like to be seeing?

in 6 months?
in 12 months?
What do you consider to be your biggest obstacle?
If I was to teach you how to explode your practice by 30-100 NPs /month, are you willing to make the needed alterations in your practice and yourself? ...And it's all incredibly honest and ethical, so you need not be concerned.
Your Thoughts:
On a scale of 1-10, please rate your level of commitment to improving your life
"I would like to increase my gross income by $ in the next 12 months."

Your Thoughts

How can I help you as a coach?
What are your expectations?
What's holding you back?

Practice Health Mini-Check Up Please take a few minutes to complete this simple practice diagnostic tool.

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