Doctor’s Name Practice Name
Office Address City/State/Postal Code Office Hours
Office Phone Number
- List your top two reasons for attending:
- a) b)
- How do you rate your clinical knowledge of clear aligner Invisalign treatment? (1= above average – 5= below average)
- Where do you need the most help? Specific clinical help needed:
- How do you feel about your office support and team member roles, specifically where can you improve?
- Do you discuss financials or pricing with your patients, if so to what extent?
- Approximately how many new patients you have each month?
- Check all the patient educational tools used in your practice:
qPt’s Photos qTypodont with aligners qStraight talk brochure qiTero
- For new patients, do you perform full exam, treatment planning and cleaning the same day or do you bring patient’s back to review treatment plan and perform needed treatment? Same Day / Bring Them Back
- To date how many Invisalign Cases have you Treated?
- Are you currently treating patients for sleep disorders?