2#**id**#Name#**label**#type_text#****#3#**id**#Best phone number to reach you#**label**#type_text#****#5#**id**#Practice location#**label**#type_text#****#9#**id**#Practice hours#**label**#type_matrix#****#10#**id**#How many weeks of  personal vacation taken annually?#**label**#type_spinner#****#11#**id**#How many ops for restorative?#**label**#type_text#****#12#**id**#How many ops for hygiene?#**label**#type_text#****#13#**id**#How long have you been practicing?#**label**#type_text#****#15#**id**#Do you own the practice? #**label**#type_own_select#****#16#**id**#-If yes, how long?#**label**#type_text#****#17#**id**#-If yes, do you feel like a ‘Business Owner’ or ‘Business Operator?#**label**#type_text#****#18#**id**#Does the practice have a clear VISION Statement? #**label**#type_own_select#****#19#**id**#- If yes- please share #**label**#type_textarea#****#20#**id**#Do you have a clear plan to achieve your Vision? #**label**#type_own_select#****#21#**id**#Rate the ‘Health’ of your Team Culture #**label**#type_spinner#****#23#**id**#Rate your External Marketing #**label**#type_spinner#****#22#**id**#Rate your Internal Marketing #**label**#type_spinner#****#24#**id**#How many ‘Active patients’? (Patient has been in for an appointment within  the past 16 months) #**label**#type_text#****#25#**id**#How many New Patients per month on average?#**label**#type_text#****#26#**id**#How many ‘days of hygiene’ (8hr shift) per week? #**label**#type_text#****#27#**id**#List all team members (first name) and position#**label**#type_textarea#****#28#**id**#When did you last ‘audit’ ALL of the systems/policies in your practice?#**label**#type_text#****#29#**id**#Is your practice assignment? #**label**#type_own_select#****#30#**id**#Do you conduct daily ‘morning huddles’ that are productive and fun? #**label**#type_own_select#****#31#**id**#Do you conduct monthly ‘team meetings’ that are productive and fun?   #**label**#type_own_select#****#33#**id**#Custom HTML33#**label**#type_editor#****#34#**id**#-To increase ‘Case Acceptance’ ? #**label**#type_own_select#****#35#**id**#-To increase ‘Efficient and Effective Scheduling’?  #**label**#type_own_select#****#36#**id**#-To handle ‘objections?  #**label**#type_own_select#****#37#**id**#-To best answer the phone/questions?  #**label**#type_own_select#****#39#**id**#- To best present ‘report of findings’ at a recall appointment?#**label**#type_text#****#1#**id**#type_submit_reset_1#**label**#type_submit_reset#****#6#**id**#Custom HTML6#**label**#type_editor#****#7#**id**#Monday #**label**#type_spinner#****##**id**##**label**##****#