Doctor Questionnaire

Please fill out the following questionnaire prior to your phone consultation with either Dr. Tom Carrico or Dr. Steve King.

Name:

Phone Number:

Email (required):

Website (if applicable):

How were you referred to Cutting Edge Chiropractic Consultants, LLC?:

Office Address:

Office square footage:

Can you expand your facility?

Office Hours:

Type of practice?

Is your billing in office or outside service?

Are your office/soap notes electronic/paperless?
YesNo

Describe your primary concern:


What do you feel is blocking your practice growth?


Explain your treatment approach/technique:


What kind of patient do you want to attract?


Have you worked with a management group in the past?
If so, which one(s)?

Office Statistics:

Average monthly patient visits
(Total visits in one year divided by 12):

Average monthly new patients
(Total new patients in one year divided by 12):

Average monthly patient updates
(Total patient updates in one year divided by 12):
Note: An update is a patient that has not been in the office for at least 6 months.

Average monthly charges
(Total charges in one year divided by 12):

Average monthly collections:
(Total collections in one year divided by 12):