Company Logo

FREE Ultimate Patient Experience PRACTICE-BUILDING STRATEGY SESSION Online Application

Dr Moffet
Please complete each of the following questions to the best of your ability- your responses to these questions will greatly aid the application process. 

These answers will not be shared with anyone and I will respect your confidentiality throughout this entire process.

After you complete these questions, simply click the button at the bottom, and your application will be submitted.

Click here if you want to apply by fax

I look forward to helping secure the success of your dental business,

Dr. David Moffet

 
 
 
Please enter all your details below, then hit the Submit button at the bottom:
 
 
 
What kind of practice do you have and how long have you been running it?
What's going on in your practice that's good?
What's going on that you'd like to change, and how long has it been going on for?
What's the biggest competitive problem you're trying to overcome, right now?
What are your current annual billings?
How much do you want to be billing, annually?
What do you feel is the major problem or obstacle responsible for the difference between what you're currently earning... and what you want to be earning?
How much revenue does an average patient generate for you?
How much money are your highest-paying patients worth to you?
How much is an average appointment worth to you?
How much is an average procedure worth to you?
What are your short-term goals? (6-12 months - personal and professional)
What are your longer-term goals? (3-5 years - personal and professional)
Tell me about a few people who've influenced you, and why?
Tell me about 2 or 3 things you've done, that you're proud of - and why.
Is there anything you WANT to be proud of, that you haven't done yet?
What are 2 or 3 things you'd like to change or improve, about yourself?
What are 2 or 3 things you'd like to change or improve, about your practice?
Do you have any hobbies or interests you enjoy, or would like to be enjoying more?
How is your mindset? Are you carrying around any self-sabotaging ideas from the past, that may be holding you back? If so, feel free to elaborate and explain.
Tell me something quirky or odd about you. (And don't worry, it's just between us!)