PracticeBuilders - The nation's leader in healthcare-practice success since 1979

If 13 questions could help increase your revenue by 10% to 50% in the next 12 months… (Well, how fast can you type?).

Find out whether you're missing out on opportunities to grow, protect or diversify your practice by completing the following Practice Self-Assessment. When you're done, we will evaluate your situation and provide a FREE Marketing Needs Analysis. If you'd like to speak directly with one of our Program Consultants, call 800-865-1494.

1. Which of the following best describes your situation?
   • I would like to grow my practice with more patients
   • I would like to grow my practice with more of a specific type of patient
   • I need to counter the effects of competition
   • I want to dominate my area
   • I am in a group practice and making marketing decisions is difficult
   • I plan to retire within the next 10 years and want to build the value of my practice for eventual sale
   • My practice is healthy but we're always on the lookout for ways to work smarter, not harder
2. Marketing is no longer optional
   • I agree
   • I'm not sure
   • I disagree
3. What is your gross revenue growth goal over the next 12 months?
   • Over 100%
   • 50% to 100%
   • 25% to 50%
   • 25% or less
4. Does your practice have a written marketing plan?
   • Yes
   • No
5. How would you rate your current marketing program?
   • Highly effective: I have a plan and I'm reaching my goals.
   • Somewhat effective: inconsistent effort or results.
   • Not effective: no plan and no measurable results.
   • NA: I do not have a marketing program.
6. How often do you ask new patients how they heard about you?
   • Always: I have a foolproof routine in place.
   • Sometimes: inconsistent and/or irregular monitoring.
   • Never: We're not in the habit/don't have time.
7. How do most of your new patients find you?
   • Advertising and public relations
   • Patient referrals
   • Professional referrals
   • Insurance listings
   • Not sure/unknown
   • Other
8. Is competition an issue?
   • Yes
   • Not Sure
   • No
9. Are you a:
   • Solo Practitioner
   • Member of a group practice with one partner or associate
   • Member of a group practice with two or more partners or associates
   • Other: (please explain):
10. What has the revenue growth trend been for your practice over the past 24 months?
    • Up strongly: Annually 25% or more ahead of prior year.
    • Up somewhat: Annually about 10% ahead of prior year.
    • Generally flat: No significant change from year to year.
    • Down somewhat: Down by about 10% from previous year.
    • Significantly down: Down by 25% or more from previous year.
11. How would you rate your staff?
    • Tremendous asset
    • Good, not great
    • Inconsistent
    • Needs help
12. What is your estimate of your current marketing budget? (Ads, gifts, website, incentives, etc.)
    • $0 - $5,000
    • $5,000 - $15,000
    • $15,000 - $30,000
    • $30,000 - $50,000
    • $50,000 - above
13. What is your desired timeline for implementing some new or different marketing ideas?
    • Yesterday
    • 30-60 days
    • No hurry - more than 60 days

Please provide the following information. Your survey results cannot be calculated without it.

^* Required

• ^*Name
• ^*Are you the practice owner
  • Yes
  • No
• If you're not the owner, what is your role in the practice?
• Practice Owner's Name
• Profession
• Specialty (if any)
• Practice Name
• ^*Address
• ^*City
• ^*State
• ^*Zip
• ^*E-mail
• ^*Phone
• Fax
• Best time to call
• Best number to call
• Home Phone (optional)
• Cell Phone (optional)

How did you hear about PracticeBuilders.com?

• Please Select E-mail Direct Mail News Article Professional Referral Magazine Ad Web Site Staff Member Search Engine Friend
• Please Provide More Detail:
  Example: Name of Publication, Search Engine Used, Web Site Name, Email Topic, Etc.
• Other: (Please specify)