Kick-Ass Accounting Questionnaire

Kick-Ass Coaching Questionnaire

I know this is a big assignment. If you hate detailed work you will not want to do it. BUT… the better your answers, the easier it will be for you to grow.

All information is kept in complete confidence.

Personal & General Info

Your Name

Your Age

What Name Do You Like To Be Called

16 Personalities 4 Letter Code + Extra letter + percentages

Your Facebook user name

(If you are not on fb, join...and "friend" Marc Hudson & Lynn McAvenia.)

Relationship status and how long together?

If you are in one, is it harmonious or is there friction?

Is it getting better or worse?

Please explain

Kids?

Names & Ages

What Country do you live in now?

How long have you lived there?

Current location of clinic?

City

How long at this location?

What chiropractic school did you graduate from?

Year of graduation?

Do you have spiritual beliefs?

Yes

Did you grow up with religion

Yes

Do you have a harmonious or tumultuous relationship with your birth family?

Do you have a history of family trauma, either in your birth or relationship family? Such as death, illness, money, kids, infidelity, bankruptcies, abuse...or anything else relevant. Please explain

What are your biggest fears?

What are your greatest passions or inspiration?

What are your hobbies?

Do you have pets?

Capacity

Get someone to time you with a stopwatch for all your procedures. It is better if you are not aware they are timing you. Do several (at least 10) and get an average. If you vary greatly from person to person depending on the case, we need to know that too. You always measure a full cycle. Meaning that your cycle of adjusting is from the initial touch, handshake or hello with one person, to the same with the next person.

How long is the patient in the practice for a New Patient Visit?

(From entering to leaving clinic: Door slam time = DST.)

How long is the DC with the patient for a New Patient Visit?

How long is the CA with the patient for a New Patient Visit?

How long is the patient in the practice for a Report of Findings Visit? (DST.)

How long is the patient with the DC for a Report of Findings Visit?

How long is the patient with the CA for a Report of Findings Visit?

How long is the patient in the practice for an Adjustment Visit? (DST.)

How long is the patient with the DC for an Adjustment Visit?

How long is the patient in the practice for a Re-exam Visit?

How long is the patient with the DC for a Re-exam Visit?

How long is the patient with the CA for a Re-exam Visit?

Do you give New Patient lectures?

How long are they?

How often do you do them?

Are they mandatory? (At what phase of care?)

If not mandatory, what % attends?

Do you do other Health classes?

Yes

How often?

When a New patient calls in for an Appointment, they will get an appointment for when? (Same day? In future?)

Same day? In future?

How many total hours per week are you open to the public for services.

Not including classes.

What times are your opening hours on each day?

If you have dedicated times for special appointments (e.g. NPs) then specify those times too.

How many total days will the clinic be open this year?

How many days of vacation did you take last year?

Did you close or have locum coverage?

If locum, what pay scheme?And for how many days?

Frequency of care

What would be your most common recommendation of care for each of the following types of patients: (Frequency of recommended visits/Period of time.)

30 year old with episodic acute LBP only seeking relief.

Asymptomatic 10 year old

Chronic 50 year old with multiple hernias on MRI

Seriously sick. MS or cancer

75 year old who is inactive, obese and has two old compression fractures.

Who creates problems with patient compliance?

MD, spouse of patient, CA, you?

Do you have a systematized ongoing educational plan?

Do you Cluster Book? If yes, please describe.

Do you reschedule missed appointments in a make up time? If so, who, how, and how effective?

Do you do patient reactivations? If so, after how long? Who, how, and how effective?

Your Goals

Monetary goal in one year?

Monetary goal in five years?

Monetary goal in ten years and beyond?

Weekly number goals in one year? Five years? Ten years and beyond?

Anything else we need to know?

Send photos of ALL your paperwork, files, business cards, brochures, ROF. Also office layout (architectural plans with load bearing walls indicated) and photos of the office.

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Kick-Ass Coaching Questionnaire

Personal & General Info

Chiropractic Practice & Philosophy:

Prices

Capacity

Money and Overhead

Advertising

Insurance

Frequency of care

Lifestyle

Physical Plan

Other procedures/products/services

Your Goals

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