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Kick-Ass Mastermind Questionnaire
Tell us about your practice and your goals.
Your Motivation
Why did you join the Kick-Ass Mastermind?
1 Year Goal
5 Year Goal
10 Year Goal
What other coaches have you worked with?
Obstacles
What are the biggest things that hold you back?
*
Economy
Spouse
Parents
Kids
Other family members
Other chiros
MDs
Distractions
Health concerns [Yours]
Health concerns [Others]
Business partners
Office procedures
Office staff
Regulatory agencies
Your location
Others
Please explain your answers above
Projects & Future
Current projects/hobbies requiring time/energy?
Big projects coming up in next 2 years?
Practice Statistics & Feedback
Avg weekly visits (last 6 mo)
Is that number up, down, or steady?
Are you happy with that number?
Avg NPs/week (last 6 mo)
Hours/week open to public
What generates your news?
What do your members complain about?
Common reasons for rejecting care?
Reasons for dropping out?
Which days are you open and what hours are you open?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Visit Times (Total Practice Member Time)
NP Visit
RoF Visit
Adjusting Visit
Re-Exam Visit
How often do you do Re-Exams?
Your (DC) Time
NP
RoF
Adjusting
Re-Exam
CA Time
NP
RoF
Adjusting
Re-Exam
Adjustments scheduled in 15m?
Initial Phase Freq. Recommendation
Do you sell prepay plans?
Yes
No
If so, what % buys a plan?
Health talk in clinic?
Yes
No
If yes, how often?
How long does it last?
Is it mandatory?
Yes
No
If not, what % attends?
The Team
Total Members
Full Time
Part Time
Hours/Week Each
What are their jobs?
Team Biggest Stress Points?
Final Questions
Where did you study Chiropractic?
When did you graduate?
How long to adjust friends/family/colleagues?
Are you a vitalist?
Yes
No
Is practice congruent w/ vitalism?
Yes
No
What is Chiropractic good for?
Is Chiropractic important?
Yes
No
Is there anything else we need to know?
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