Temple of Success Practice Analysis Questionnaire

Your Name: *

Please Enter Your Full Name

Your Email Address: *

Please Enter Your Email Address.

Your Phone Number: *

Please Enter Your Phone Number.

Good Times To Contact: *

Please enter some generally good days and times to contact you about your practice analysis.

Approximately how many clients/patients do you work with per week?:

How many would you like to see?:

Are you currently on any insurance panels, if so which ones and what percentage of your practice is insurance panel clients?:

Do you currently market your practice? If so, how?:

Do you have a website? If so, what is the address and how many referrals a month come from your website?:

Do you offer any other services, ie, groups, workshops, training, etc.?:

How long have you been in practice?:

What are your biggest challenges in your practice?:

What are your goals for your business in the next 1-3 years? 5-10 years?:

What are your strengths?:

What are your top 3 referral sources?:

What city and state is your practice located and are there any issues based on location?:

What do you currently charge?:

What is the average fee for service in your area?:

What is your niche or specialty(s)?:

What is your yearly marketing budget?:

What type of practice do you currently have or thinking of starting and what is your degree and training?:

When is the last time you raised your fees?: