Winners Edge Chiropractic Consulting

Doctor Name:

Email Address:

Practice City:

Practice State:

How did you hear about us?

Friend
Magazine Article

Internet
Received a Mailing

Received a Call
Heard Dr. Robson Speak

Other:

Years in Practice:

Years in Current Location:

Number of DC's in your office:

Number of CA's in your office:

Do you have:

Decompression Laser Weight Loss Other

Techniques you use:

Past consultants you have worked with:

Your hours are:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

The current time YOU think you take for a:

New Patient:

5 - 10 min 10 - 20 min 20 - 30 min over 30 min

Report:

Under 5 min 5-10 min 10-20 min over 20 min

I do a group report/orientation

Office visit:

under 1 min 1-2 min 3-4 min over 5 min

Do you have a weekly team meeting?

Yes No

How would you rate your depth of chiropractic philosophy?

Low Medium High I read Green Books all the time.

Are you happy with your office location and space?

Yes No

How much is the total rent?

How many square feet is your office?

Do you think your office, or office layout is restricting growth?

Yes No

How many visits a week are you currently seeing on average?

Patients in one day:	Goal:
Collections in one day:	Goal:
Visits in a week:	Goal:
Collections in a week:	Goal:
Collections in a month:	Goal:
Collections in a year:	Goal:
New Patients in a week:	Goal:
New Patients in a month:	Goal:

Treatment Time

Confidence

Money Handling

Acquiring New Patients

Staff Issues

Increasing Income

Debt Reduction

Insurance Billing

Cash Practice

Business

Promotion/marketing

Goal Setting

Retention

Organization

Saving Money

Time Management

PI Building

Elevating Image

Yes No	Are you paying your taxes weekly?
Yes No	Are you saving money pre-tax weekly?
Yes No	Are you saving post-tax weekly?
Yes No	Are your student loans paid off?
Yes No	Are your business loans paid off?
Yes No	Are you seeing as many patients as you'd like?
Yes No	Is your net income as much as you would like?
Yes No	Is your overhead as low as you would like?
Yes No	Are you working the hours and schedule that you would like?
Yes No	Do you have your retirement strategy figured out?
Yes No	Do you have a way to get as many new patients as you would like?
If you answered NO to any of these you should consider joining Winners Edge immediately.

What 3 main things do you want to see change?

1.

2.

3.

The biggest thing stressing you out right now is:

Are you aware that you might be the problem?	Yes No
Are you willing to do what it takes to improve?	Yes No

You would hire a coach if the coach could show you how to:

Location:	Contact:
8345 Crystal View Road #100 Eden Prairie, MN 55344	Phone: 952.943.2442 E-mail: info@winnersedgeconsulting.com
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