GAME PLAN PREPARATION FORM Step 1 of 23 4% GENERAL INFORMATIONName: First Last Email: Do you have a business partner?YesNoBusiness Partner Name First Last Business Partner Email Practice:Website: Number of years in the practice?How many surgeries do you, personally operate out of each day?How many additional surgeries do you have that are not fully equipped? GENERAL INFORMATIONDo you have space to build additional surgeries?YesNoIf yes, how many surgeries?Do you have a private office?YesNoDo you have a consultation room separate from you private office?YesNoHow many metres of space do you have in total?Do you rent or own your premises?RentOwnIf you rent, when does you lease expire?Are you anticipating remodelling?YesNoIf yes, when are you planning to remodel?Are you anticipating moving?YesNoIf yes, when are you anticipating the move?Do you have a hygiene department?YesNoHow many hygiene days do you have per week?How many patients are in your active patient base (based on the past 18 months)?Do you employ a therapist?YesNoAre you involved in a partnership?YesNoAre you involved in an associateship?YesNoDo you have an assistant dentist?YesNoIf so how many assistant dentists do you have?How many assistant dentist days do you have per week? STAFFIf you answered “Yes” to having an Assistant Dentist(s), Hygienist(s), Therapist(s), please describe:a. How many hours they work per week?b. How they are compensated? (i.e. 35% commission on receipts after lab)If you answered “Yes’” to having a partner and/or associate, please describe:a. How many dentists are in you practice and their position (i.e. Assistant Dentist, Associate Dentist or Partner)b. What assets are shared (i.e. Telephone number, computers, etc.)?c. What staff is shared, if any (i.e. reception, sterilization nurse)?d. How expenses are allocated (divided equally, divided as a percent of production, divided as a percent of collection, etc)?e. How long the arrangement has been in place (i.e. how long you have had your current partner(s) and/or associates(s))?f. Describe the documentation that creates the arrangement (i.e. a partnership agreement, a buy in agreement, etc). (Please attaché a copy of the documentation to this form )g. How you distribute patients?h. Whether you each have your own separate patient base or whether you do cross production (i.e. work on the same patients)? GENERAL FINANCEWhat is your monthly turnover? (Based on the last 3 months)What is your monthly goal for turnover?Do you schedule your treatments a month to this goal?YesNoWhat is your collection percentage?How much do you have outstanding in accounts receivable?What is you overhead percentage?Are you participating in any preferred provider programmes?YesNoIf yes, which programmes?How often are they paid to you?Do you extend financial arrangements in order to increase case acceptance on comprehensive cases?YesNoWhat is your current net salary per week?Is it enough?YesNoIf no, how much more do you need?Are you funding your superannuation?YesNoIf yes, at what amount annually?When do you plan to retire? Fee IncreaseWhen did you last raise you treatment fees?Did you increase all your treatment fees or some?YesNoWhich service fees were raised?What was the percentage increase?Will you be increasing your treatment fees in the next 12 months?YesNoWhen will you increasing your treatment fees?Which treatment fees will you be raising?By how much will the treatment fees be raised by? General Working WeekWhat is your general working week?Day of the WeekWork HoursOperating Hours How many hours per week are you booked for?a. Clinicalb. Administrationc. Staff Meetings Patient InformationHow many new patients do you see each month on an average? (Based on the last 12 - 18months)?How long is your new patient exam?What does the new patient exam comprise of?Do you diagnose and present quadrant dentistry?YesNoDo you track your case acceptance?YesNoIf yes, what is it for new patients?If yes, what is it for existing patients?What is the size of your patient base? (Based on the last 18 months)How far ahead are your appointments? Team AnalysisPlease list names of your staff, their position, length of employment and the number of hours they work per week. Then, score the performance of each staff member, on a scale of 1-10, with 10 being the highest. (You should consider their overall performance, their contribution to the practice and their team participation in determining their score) Please rank yourself as well. (Note: If you have more than 10 employees, please photocopy this page)Employee NamePositionWeekly WageHourly WageHours/ WeekAnnual Salary at current wage (Gross)Length of EmploymentType of EmploymentOverall Score GoalsWhat Does Your Business Look Like In 5 Years?1. Turnover2. Net Profit3. The amount of time you HAVE to work in your business e.g. 1 day per week or none4. Your Team i.e. How many people will you need to achieve your turnover GoalsWhat Does Your Business Look Like In 3 Years?1. Turnover2. Net Profit3. The amount of time you HAVE to work in your business e.g. 1 day per week or none4. Your Team i.e. How many people will you need to achieve your turnover GoalsWhat Does Your Business Look Like In 1 Years?1. Turnover2. Net Profit3. The amount of time you HAVE to work in your business e.g. 1 day per week or none4. Your Team i.e. How many people will you need to achieve your turnover Practice Max SuccessMy participation in the Practice Max Programme will be successful when: Practice Max SuccessName First Last Business:Phone Number:No. of EmployeesPractice Turnover: Practice Max SuccessThe following questionnaire has been designed to help you rate your business in relation to the Practice Max Success Matrix. We have identified these key areas of a practice that contribute to business success, profitability and balance. Answer each question and rate your practice by selecting from 1 through 5 in the scoring column based on the degree which you have accomplished each item. Once complete, please save and return to Dr Jesse Green by email to email@example.com. If you have any questions, please contact Jesse on 0416 030 711.1. VALUESStrongly disagreeDisagreeNeutralAgreeStrongly agreeWe are clear about our core values and the actions that bring them to life.As the owner, I am clear about my life's purpose (my 'why') and how my practice is a reflection of that.I regularly communicate my vision for the business and the role the team has in bringing the vision to life.My philosophy of care is documented and shared with the team and with patients.I know what my 'Sweet Spot' is and stay there.We have a culture of excellence and strive for continual improvement.We believe that servicing the patient is as important or even more important than making the 'sale'.Our practice follows through. We do what we say we will.Our practice continuously under promises and over delivers.We have a clear mission statement. Practice Max Success2. LEADERSHIPStrongly disagreeDisagreeNeutralAgreeStrongly agreeI possess a clear vision of where the company is going and have written it out in detail.The company culture is defined, cooperative and forward thinking.The company provides social activities for the team.I have a complete contingency staffing plan in place.My staff treats their job as a career, not a short term financial fix.I encourage my staff to set career and personal goals.Decisions and work are pushed down the hierarchy as far as possible.I continuously let my people know when I am proud of their work.Ideas for improvement that originate from the team are regularly introduced into the business.I am developing myself and leading by example, clear that who I am reflects on the success of the business.I set expectations clearly and motivate and inspire "buy in" from the team.My 1 year personal and business goals are set.I track, measure and review the key drivers of the business.I empower people to perform at their best. Practice Max Success3. FINANCIAL INTELLIGENCEStrongly disagreeDisagreeNeutralAgreeStrongly agreeThe practice has an annual budget (forecast) in writing from which to work.Budgeting processes are clearly defined and adhered to.Each clinician knows their daily financial goal and has a process to achieve it while staying in their 'sweet spot'.Financial statements are done monthly, at the very minimum.Loan payments are current and in line with the agreements.Suppliers' and Service Providers' invoices are routinely paid by due date.Inventories are monitored daily or weekly to ensure maximum turnover and minimal financial outlay.Terms are negotiated with all suppliers including early payment discounts.All budgeting is done from an optimistic perspective.The company has the cash flow to achieve its objectives.Profitability as a rule is higher than the industry average and is not an issue for the company.Debt service as a percentage of gross profit decreased last year. Practice Max Success4. SMART SYSTEMSStrongly disagreeDisagreeNeutralAgreeStrongly agreeThe practice has a scheduling system in place to support the financial goals of the practice.The appointment book is templated to an ideal day.The team has a morning meeting each day to focus on the day ahead.We have a recall system that includes following up patients who don’t book appintments.Where possible we aim to pre-book recall examinations at this appointment.The practice has a systematic approach to handling cancellations and lateness.We run on time.The practice has regular staff meetings to discuss improvements that can be made to the practice.We systematically build value for the treatment provided to patients.We build loyalty and case acceptance through the new patient examination.We have a systematic approach to recruiting A grade players to our team.We have an induction and training system in place for new team members.We have a simple document to explain terms of employment.We assess the team's performance regulalrly and conduct Staff Development Meetings regulalry.We know and track the High Value Activities that drive our practice.Every meeting accomplishes some specific objective or outcome.Individual staff tasks are rated by level of urgency and importance. Practice Max Success5. GETTING TO 'YES'Strongly disagreeDisagreeNeutralAgreeStrongly agreeI monitor how successful I am at having treatment accepted.We know the average value of each new patient.I have a framework to understand what my patients emotional motivators and concerns are.I have a process in my examination that facilitates case acceptance.The team knows when a follow up consultation is useful to assist case acceptance.The team knows how to handle 'objections'.The team has well developed verbal skills.The practice has a written Financial Policy.The team (not the doctor!) negotiate financial terms with patients. Practice Max Success6. ART OF MARKETINGStrongly disagreeDisagreeNeutralAgreeStrongly agreeThe practice has found a niche for its product / service and no longer competes on price.We track our leads, our patient conversion rate and the number of transactions per patient, continuously.We have mapped the patient touchpoints in the practice.We have systemised the patient experience so it is consistent irrespective of which staff are rostered.We build value before, during and after treatment.We have a program to actively retain patients.We actively ask patients for referrals and measure how many receive.We have a reactivation program which we emply at least quarterly.We survey people who leave our practice.The practice has an online engagement strategy.The practice has an effective social media strategy.We track the return on investment on any external marketing.We have a practice brochure which we use as a communication tool.Are you doing it to get it done or are you doing it to do it better? Practice Max Success7. WINNING TEAMStrongly disagreeDisagreeNeutralAgreeStrongly agreeEveryone is aware of the lifetime value of our clients and that value is increasing continuously.The practice has an organisiation chart with each role clearly outlined.Each role has a job description with responsibilities and accountabilities.Every member of the team is operating at their full potential.The company provides and engages in ongoing team training.There is synergy among all the members of our team.People are listened to and are encouraged to speak up and make recommendations.The team always remains positive and does not tolerate negativity among its members.The team sees change as positive and is always ready for challenges.My team members are accountable and never make excuses for performance.We assess the team's performance and conduct Staff Development Meetings regularly.Each team member is in a role that suits their natural strengths.Every member of the team enjoys their work.Staff and facilities are being utilized to at least 80% of their potential. Practice Max Success8. PRODUCTIVITYStrongly disagreeDisagreeNeutralAgreeStrongly agreeOperations are, for the most part, fully automated and computerized.Designated people are responsible for the day to day operating decisions.Staff complete work, nothing is redone or substandard.Staff communication is good and duplication of work does not occur.The company is driven by both quality and profit, and both are measured regularly.Meetings between staff are scheduled in advance / spur of the moment encounters are avoided.Staff have the opportunity to openly communicate about obstacles to their production.The staff have the environment, equipment and the training they need to double their productivity.Work harder ON your business, not IN your business Practice Max Success9. PROFITABILITYStrongly disagreeDisagreeNeutralAgreeStrongly agreeProfit margins have increased over the last three years.Profits will increase this year by no less than 10%.Debt service as a percentage of gross profit decreased last year.The ratio of the company's total debt to equity has decreased over the last year.Break even levels are relatively low.Individual responsibilities for achieving financial goals are clearly defined.The company is one of the leaders in the market.Our pricing policies are not tied to the competition and market leaders. Game On!You have committed to taking your practice to the next level and this will require you to make some changes and put in some serious work. Change can be uncomfortable. It can also be exhilarating. We challenge you to play at your highest level to maximise your results.I commit to... Taking responsibility and being accountable Being big enough to step outside my comfort zone and get on with it Giving 100 % and playing full out, even when it hurts Doing what needs to be done Doing what I say I’m going to do Focusing on what matters Taking what I do seriously Not taking myself too seriously Celebrating the wins Seeing mistakes and failure as part of growth Having some fun along the way Participant SignaturePrinted NameDate Date Format: MM slash DD slash YYYY NumberCAPTCHAEmailThis field is for validation purposes and should be left unchanged.