What Quality of Life is your practice affording you?

Dr. Short will personally and confidentially receive your answers to the questions below. Once he has reviewed your answers he will personally reply to you via email, and let you know the areas he sees that you could be working on to improve your practice and life.

There is NO commitment from taking this survey, it is only to allow Dr. Short a snapshot into your practice to help identify areas he feels could increase your success, with or without working together.

You have nothing to lose, and will receive valuable feedback based off the answers you submit. The more detailed you are the more valuable the feedback will be!

First Name
Last Name
How would you describe your location: ie. rural, suburban, urban.

In your own words how would you describe your practice?

How long have you been in practice?

What was your last year’s production/collections? (ballpark if needed)

What is your average MONTHLY productions/collections for this year?

How many ops do you have?

How many team members? Which Positions?

How many new patients do you average a month?
What are you currently doing for marketing?
How much are you currently spending on marketing per month?
How many days a week do you work?
How many weeks of vacation do you take a year?
When was your last vacation?
What is your level of satisfaction with your team’s overall performance?
What would be the ideal # of days to work a week or month for you?
What would be the ideal # of vacations weeks per year for you?
What would you like to produce/ collect a year? (3-5 years out)
What would be the biggest obstacle that would keep you from hitting that goal?
What are some things going really well in your practice right now?
What are some things that need the most improvement?
What procedures do you currently refer out?
On average how many crowns do you do a month?
What’s the best email address for Dr. Short to send you his thoughts on your current situation?
How did you hear about The Lifestyle Practice?

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