2*:*id*:*type_text*:*type*:*Name*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:*300*:*w_size*:**:*w_first_val*:**:*w_title*:*yes*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*3*:*id*:*type_text*:*type*:*Best phone number to reach you*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:*300*:*w_size*:**:*w_first_val*:**:*w_title*:*yes*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*5*:*id*:*type_text*:*type*:*Practice location*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*yes*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*9*:*id*:*type_matrix*:*type*:*Practice hours*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:*text*:*w_field_input_type*:****Monday***Tuesday***Wednesday***Thursday***Friday***Saturday***Sunday*:*w_rows*:****AM***PM*:*w_columns*:*no*:*w_required*:*wdform_matrix*:*w_class*:*100*:*w_textbox_size*:**:*new_field*:*10*:*id*:*type_spinner*:*type*:*How many weeks of  personal vacation taken annually?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:*40*:*w_field_width*:*0*:*w_field_min_value*:**:*w_field_max_value*:*1*:*w_field_step*:*null*:*w_field_value*:*no*:*w_required*:*left-label*:*w_class*:**:*new_field*:*11*:*id*:*type_text*:*type*:*How many ops for restorative?*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:*300*:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*12*:*id*:*type_text*:*type*:*How many ops for hygiene?*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:*300*:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*13*:*id*:*type_text*:*type*:*How long have you been practicing?*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:*300*:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*15*:*id*:*type_own_select*:*type*:*Do you own the practice? *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*16*:*id*:*type_text*:*type*:*-If yes, how long?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*17*:*id*:*type_text*:*type*:*-If yes, do you feel like a ‘Business Owner’ or ‘Business Operator?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*18*:*id*:*type_own_select*:*type*:*Does the practice have a clear VISION Statement? *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*19*:*id*:*type_textarea*:*type*:*- If yes- please share *:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size_w*:*100*:*w_size_h*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:**:*new_field*:*20*:*id*:*type_own_select*:*type*:*Do you have a clear plan to achieve your Vision? *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*21*:*id*:*type_spinner*:*type*:*Rate the ‘Health’ of your Team Culture *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:*40*:*w_field_width*:*0*:*w_field_min_value*:*10*:*w_field_max_value*:*1*:*w_field_step*:*null*:*w_field_value*:*no*:*w_required*:*left-label*:*w_class*:**:*new_field*:*23*:*id*:*type_spinner*:*type*:*Rate your External Marketing *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:*40*:*w_field_width*:*0*:*w_field_min_value*:*10*:*w_field_max_value*:*1*:*w_field_step*:*null*:*w_field_value*:*no*:*w_required*:*left-label*:*w_class*:**:*new_field*:*22*:*id*:*type_spinner*:*type*:*Rate your Internal Marketing *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:*40*:*w_field_width*:*0*:*w_field_min_value*:*10*:*w_field_max_value*:*1*:*w_field_step*:*null*:*w_field_value*:*no*:*w_required*:*left-label*:*w_class*:**:*new_field*:*24*:*id*:*type_text*:*type*:*How many ‘Active patients’? (Patient has been in for an appointment within  the past 16 months) *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*25*:*id*:*type_text*:*type*:*How many New Patients per month on average?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*26*:*id*:*type_text*:*type*:*How many ‘days of hygiene’ (8hr shift) per week? *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*27*:*id*:*type_textarea*:*type*:*List all team members (first name) and position*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size_w*:*100*:*w_size_h*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:**:*new_field*:*28*:*id*:*type_text*:*type*:*When did you last ‘audit’ ALL of the systems/policies in your practice?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*29*:*id*:*type_own_select*:*type*:*Is your practice assignment? *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*30*:*id*:*type_own_select*:*type*:*Do you conduct daily ‘morning huddles’ that are productive and fun? *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*31*:*id*:*type_own_select*:*type*:*Do you conduct monthly ‘team meetings’ that are productive and fun?   *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*33*:*id*:*type_editor*:*type*:*Custom HTML33*:*w_field_label*:*Has your team been properly trained with ‘quality communication skills...*:*w_editor*:**:*new_field*:*34*:*id*:*type_own_select*:*type*:*-To increase ‘Case Acceptance’ ? *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*35*:*id*:*type_own_select*:*type*:*-To increase ‘Efficient and Effective Scheduling’?  *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*36*:*id*:*type_own_select*:*type*:*-To handle ‘objections?  *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*37*:*id*:*type_own_select*:*type*:*-To best answer the phone/questions?  *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*39*:*id*:*type_text*:*type*:*- To best present ‘report of findings’ at a recall appointment?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*40*:*id*:*type_text*:*type*:*Average Monthly practice production?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*41*:*id*:*type_text*:*type*:*-Doctor production?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*42*:*id*:*type_text*:*type*:*-Hygiene production?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*43*:*id*:*type_text*:*type*:*-Average monthly A/R?*:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_regExp_status*:**:*w_regExp_value*:**:*w_regExp_common*:**:*w_regExp_arg*:*Incorrect Value*:*w_regExp_alert*:*no*:*w_unique*:*no*:*w_readonly*:**:*new_field*:*45*:*id*:*type_own_select*:*type*:*Is your team able to ‘bonus’ on a monthly basis?  *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*46*:*id*:*type_textarea*:*type*:*List 3 Areas of the practice that you feel work really well*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size_w*:*100*:*w_size_h*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:**:*new_field*:*47*:*id*:*type_textarea*:*type*:*List 3 Areas of the practice that you feel need attention*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size_w*:*100*:*w_size_h*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:**:*new_field*:*49*:*id*:*type_own_select*:*type*:*Have you ever worked with a dental coach or consultant?  *:*w_field_label*:**:*w_field_label_size*:*left*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select***Y***N*:*w_choices*:*true***false***false*:*w_choices_checked*:*false***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:*Select***Y***N*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*48*:*id*:*type_textarea*:*type*:*Please list anything else that you feel I would benefit from knowing*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size_w*:*100*:*w_size_h*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:**:*new_field*:*50*:*id*:*type_own_select*:*type*:*Select*:*w_field_label*:**:*w_field_label_size*:*top*:*w_field_label_pos*:*no*:*w_hide_label*:**:*w_size*:*Select value***option 1***option 2*:*w_choices*:*true***false***false*:*w_choices_checked*:*true***false***false*:*w_choices_disabled*:*no*:*w_required*:*yes*:*w_value_disabled*:****option 1***option 2*:*w_choices_value*:********:*w_choices_params*:*wdform_select*:*w_class*:**:*new_field*:*1*:*id*:*type_submit_reset*:*type*:*type_submit_reset_1*:*w_field_label*:*Submit*:*w_submit_title*:*Reset*:*w_reset_title*:**:*w_class*:*false*:*w_act*:**:*new_field*:*