|
Name
|
|
Address
|
|
City
|
State
|
|
Zip
Code
|
Phone
|
|
Fax
|
Email
Address
|
| 1.
Dental Specialty
|
| 2.
Number of Dentists in your practice?
|
| 3.
Number of Hygienists in your practice?
|
| 4.
Number of Assistants in your practice?
|
| 5.
Number of Business Staff in your practice?
|
|
6.
Number of Operatories in your facility?
|
|
7.
Are you right-handed or left-handed?
|
|
8.
I am using the following type of dental light. (check one)
Overhead track
Fixed ceiling mount
Chair mount
Other
|
| 9.
Primary Dental Supplier?
|
| 10.
Secondary Dental Supplier?
|
|
11.
Have you considered any preliminary budget requirements for you project?
Yes
No
|
|
12.
If yes, what is your preliminary budget?
|
|
13.
Do you currently own a intraoral camera system?
Yes
No
|
| 14.
If yes, what brand?
|
|
15.
If a cart based system, do you feel it is as efficient as it should
be?
Yes
No
|
|
16.
What features of an intraoral camera are most important to you ?
A.
B.
C.
|
|
17.
Any interest in CDI, DVD, or VCR patient education programs?
Yes
No
|
|
18.
Have you considered a multiple operatory video network system?
Yes
No
|
|
19.
Any interest in Cable TV, Digital Satellite Systems or a VCR for patient
entertainment ? Relaxation?
Yes
No
|
|
20.
Are you currently using practice management software options?
Yes
No
|
|
21.
If yes, which software package are you using currently?
|
|
22.
Are you considering other practice management software options?
Yes
No
|
|
23.
If yes, which software package are you considering?
A.
B.
C.
|
|
24.
Do you have any interest in a consulting group that specializes in helping
dentists select the best practice management software program(s) for
their office needs?
Yes
No
|
|
25.
Do you currently own a website for your practice?
Yes
No
|
|
26.
If yes, are you satisfied with its aesthetics, function and effectiveness?
Yes
No
|
|
27.
Would you like T2's help designing a website specifically for your office?
Yes
No
|
|
28.
Create a "Top 5" wish list (#1 being most important) of
technology products that you would like to integrate into
your practice.
1.
2.
3.
4.
5.
|
|
29.
Do you prefer more simplified technological systems
(with fewer options available) involving mostly
button pushing?
Yes
No
|
30.
On average, how many hours a week do you devote to
computer related functions?
|
|
31.
Are there any other systems requirements that we should know about?
|
|
32.
Do you have any specific other systems requirements on how T2 Consulting
can assist you in meeting your high tech goals?
|
