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Core Discovery
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Practice Name
*
Please upload the following:
Photos of the Office:
Front Landscape/Main Sign
Building Entry (Front Door, Reception Area)
Treatment Presentation/Consultation Room
Window Views
Unique Technology Equipment
Snapshots of staff and doctor(s)
Unique Architectural Elements
Unique Art or Décor Around the Office
Upload Office Photos
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Drop a file here or click to upload
Choose File
Maximum upload size: 2.1MB
Photos or Scans of existing Office Communication Materials:
Letterhead
Envelopes
Business Cards
Appointment Cards (front & back)
Recare Cards (front & back)
Practice Brochure (not supplied product brochures)
Note Pads
Folders
Doctor's Bio Sheet
Upload Office Materials
Drop a file here or click to upload
Choose File
Maximum upload size: 2.1MB
Photos or Scans of Past/Current Marketing:
Newspaper Ads
Yellow Pages
Direct Mail
Newsletter
Patient Referral Program
Magazine Ad
Upload Marketing Materials
Drop a file here or click to upload
Choose File
Maximum upload size: 2.1MB
List staff by job titles.
*
Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name: Job Title: Name:
Check off Cosmetic dental procedures offered by the practice.
*
Porcelain Crowns, Veneers and Bridges
On-site Restoration Milling
Cosmetic Imaging
Lumineers
SnapOn Smile
Esthetic Dentures
Direct Composite Bonding
Porcelain Inlays & Onlays
Amalgam-Free Practice
In-Office Power or Tray Whitening
Invisalign or other Clear Braces
Check off Family/Children dental procedures offered by the practice.
*
Fluoride Application
Cleanings
Sealants
Oral Cancer Screenings
Blood Pressure Screenings
Sleep Apnea Devices
Stop Snoring Devices
Sports Mouth Guards
Orthodontics
TMJ/Malocclusion treatment offered by the practice.
*
Bite Splint
Tens Unit
Equilibration
Invisalign
Surgery
Functional Restorations
NONE
Sedation treatment offered by the practice.
*
Counseling
Hypnosis
Nitrous
Calming Pre-Medication
Sedation Pill
Sedation Injection
IV Sedation
NONE
Dental Implant treatment offered by the practice.
*
Oral Surgery
Restorations Only
Single Missing Tooth
Implant Supported Bridge
Implant-Secured Denture
Implant-Secured Partial Denture
NONE
If you use an on-site restoration milling system, which one do you use?
If you use a digital radiography system, which one do you use?
If you use a soft-tissue laser system, which one do you use?
If you use a stop snoring system, which one do you use?
If you use a digital impression system, which one do you use?
If you use a patient education system, which one do you use?
If you use a CT system, which one do you use?
If you use a migraine treatment system, which one do you use?
If you use an oral cancer screening system, which one do you use?
What other technologies do you offer?
Diagnodent
Intra-Oral Camera
T-Scan
Diagnostic Wax-Up
Electrosurgery
Radio Surgery
Air Abrasion
Tomography
Single-Tooth Anesthesia
Cavitron
Fiber Optic Transillumination
Panorex
Oraverse
Articulator
Microscope
Magnifying Optics
Bacterial Analysis
Computerized Anesthesia
"Fast" Orthodontics
Digital Records
What other technologies not mentioned do you offer?
What patient comforts do you offer?
Overhead OperatoryTVs
Large Reception Area TV
WiFi
Multi-Media Virtual Glasses
Bottled Water
Wine
Juices
Fresh-Brewed Tea
Music Headphones
Massage
Steam Towels
Aroma Therapy
Noise-Cancelling Headphones
Wax Hand Dip
Coffee/Espresso
Financial Options Offered
*
Care Credit
Mastercard
Visa
AmEx
Discover
Personal Check
In-House Dental Plan
In-House Financing
Patient Pays Residual After Insurance
Straight Fee-For-Service
PPO
Practice Address: Street, City, State, ZIP
*
Website Domain Address
Phone Number
*
Primary Practice Email Address
*
Primary Doctor's Email Address
*
Liaison Staff Member's Name if not the Doctor
List Office Hours
*
Monday Open: Monday Close: Tuesday Open: Tuesday Close: Wednesday Open: Wednesday Close: Thursday Open: Thursday Close: Friday Open: Friday Close: Saturday Open: Saturday Close:
Practice Facebook Page URL (if non-existant, enter N/A)
*
Practice Google+ Page URL (if non-existant, enter N/A)
*
Practice YouTube Page URL (if non-existant, enter N/A)
*
Practice Twitter Page URL (if non-existant, enter N/A)
*
Submitted by: (please enter full name)
If you want to print the completed Discovery to refer to during the telephone Discovery Conference, you must do so BEFORE you send us the completed form.
Copyright 2015, Curtis Marketing Group, Inc. Do not use without written permission from Curtis Marketing Group, Inc.
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Curtis Group
9402 November Dr
St. Joseph, MN 56374
Phone: 1-320-363-0210
Fax: 1-320-363-0218
Email:
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