Orthodontics Marketing Questionnaire

Practice Name*

Your Name*

First Last

Online Presence

We have more than one website.*

Yes
No

If yes, the other addresses are:*

Our practice currently uses the following:*

We have a link strategy with keywords and tags that are optimized to help patients find us using our most important offerings.*

Yes
No

Our site is optimized for mobile.*

Yes
No

We currently have a strategy for obtaining reviews.*

Yes
No

General

Our practice has the following number of locations.*

We are planning on expanding.*

Yes
No

Our practice has the following total number of treatment chairs.*

Our practice has the following total number of separate consultation rooms.*

The following number of partners are in our practice.*

The following number of associates are in our practice.*

We have a plan to add more associates or partners.*

Yes
No

Doctor compensation methodology used:*

Equal division of income
Production-based division
Hybrid of shares/division
None of the above

I’d like to increase my production by:*

We have an annual marketing budget.*

Yes
No

We participate with dental insurance plan(s).*

Yes
No

We participate with Medicaid.*

Yes
No

Technology

We use the following practice management software.*

We take digital X-rays at our office.*

Yes
No

If yes, we use the following brand of digital X-rays.*

Our digital X-rays are fully integrated with our practice management software.*

Yes
No

We use an intra-oral scanner in our office.*

Yes
No

If yes, intra-oral scanner is the following brand.*

The primary use for our intra-oral scanner is: (Check all that apply)*

In place of impressions to create study models, retainers, and/or other appliances
Electronic submission of cases to Invisalign®
Other (please indicate)

If other, please indicate.

We encourage our patients to complete their patient registration forms online.*

Yes
No

The following percentage of patients complete their patient registration forms online.*

We currently use an automated appointment confirmation system.*

Yes
No

If yes, which one?*

We use a digital referral communication system.*

Yes
No

Our referring doctors submit referral slips to our office using the following method(s): (Check all that apply)*

Send physical slip with patient
US Postal Service
Fax
Email
Electronic submission through our website or some other digital referral management system
Other (please indicate)

If other, please indicate.

We have TVs in our reception area.

Yes
No

We have TVs in our operatories/consultation rooms.

Yes
No

We currently use informed consent videos.

Yes
No

We offer free Wi-Fi for our patients.

Yes
No

Staffing

We have the following number of doctors on staff.*

The following number of doctors work full-time (3–5 days/week).*

The following number of doctors work part-time (1–2 days/week).*

We have the following number of employees on staff.*

The following number of admin staff work full-time (4–5 days/week).*

The following number of admin staff work part-time (1–3 days/week).*

The following number of clinical staff work full-time (4–5 days/week).*

The following number of clinical staff work part-time (1–3 days/week).*

The total number of people that we employ within each of the following generations is as follows.

Baby Boomers (1946–1964)*

Generation X (1965–1981)*

Millennials (1982–1995)*

Generation Z (1996–later)*

We have a Practice Administrator or Office Manager.*

Yes
No

We have a staff member responsible for marketing.*

Yes
No

We employ Treatment Coordinator(s).*

Yes
No

If yes, how many?*

Our practice’s primary contact person for our referrals is: (Check all that apply)*

If other, please state the position.

Our employee turnover in the last 4 years has been:

2016*

Total Employee Turnover	Qty That Resigned	Qty That Were Terminated	Qty That Retired

2017*

Total Employee Turnover	Qty That Resigned	Qty That Were Terminated	Qty That Retired

2018*

Total Employee Turnover	Qty That Resigned	Qty That Were Terminated	Qty That Retired

2019*

Total Employee Turnover	Qty That Resigned	Qty That Were Terminated	Qty That Retired

Referrals and Community Involvement

We have the following number of referring offices in each category/revenue bracket.

$100,000+

$99,999–$75,000

$74,999–$25,000

$24,999 or less

We conduct Lunch-n-Learns with our referring offices.*

Yes
No

If yes, how often?*

1–3 per year
4–6 per year
7 or more per year

We are involved with a study club.*

Yes
No

If yes, our role is:*

We meet:*

Monthly
Quarterly
Semi-annually
Other

If other, please specify.*

We are involved in the following type of study club:*

Spear Study Club
Seattle Study Club
Other

If Other, please indicate.*

We currently market to practices using:*

Gift Baskets
Dinners
Sporting Events
Other

If Other, please indicate.

We participate in/sponsor at least one community charity drive per year.*

Yes
No

We have seen the following percentage of decline in referrals in each of the following specialties:

General Dentists*

Oral Surgeons*

What are your biggest marketing concerns & challenges?*

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Orthodontics Practice Questionnaire