Dental Practice Name
*
Your Position in Practice
*
City
*
State
*
Do you currently place dental implants in your practice?
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Yes, we place implants in-house
We diagnose but refer implant cases out
No, but we plan to start placing implants
On average, how many implant cases do you start per month right now?
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0
1-2
3-5
6-10
11+
Do you have room in your schedule to take on more implant cases over the next 3–6 months?
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Yes, we have plenty of room
Yes, we have some room
Not right now
What would you like your implant cases to look like 12 months from now?
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About the same as now
Around 5 more implant starts per month
Around 10+ more implant starts per month
Not sure – I’d like guidance on what’s realistic
What are you averaging in terms of collections on a monthly basis?
*
What's your goal for collections per month?
*
What's your most immediate problem with regards to marketing?
*
First Name
*
Last Name
*
Phone
*
Email
*
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