1.
Are your hours listed on your
door, or your appointment card, or your 'Welcome
to Clinic' letter, etc?
YES
NO
2.
Have you
formally assessed and reviewed your clinic furnishings,
ambience, policies and procedures in the past year?
YES
NO
3.
Do you have
more than one phone line for incoming calls?
YES
NO
Do you have
'message' or 'music' on hold?
YES
NO
Do you use
a chiropractic-specific message on hold?
YES
NO
4.
Do you use an answering
machine or answering service?
YES
NO
Is your phone attended
out of office hours?
YES
NO
5.
Do you record your
practice statistics daily?
YES
NO
Including Accounts
Receivable Total?
YES
NO
Including 'no charge'
total?
YES
NO
6.
In
your appointment book:
Are special visits (eg New Patient)
recorded?
YES
NO
Are totals kept?
YES
NO
Are multiple appointments made
in advance for patients?
YES
NO
Do you have a colour-coded system
in your appointment book?
YES
NO
7.
Have you established
recall systems?
YES
NO
For:
Missed appointments?
YES
NO
Reminder calls?
YES
NO
Rebooking archived patients after
e.g. 6 months?
YES
NO
8.
Do your patients
print their names on an Arrival Register?
YES
NO
Do you retain these registers
for your records?
YES
NO
9.
Are New Patient Files
prepared in advance?
YES
NO
10.
Do you have an established
written Office Policy and Procedure Manuals?
YES
NO
For patients?
YES
NO
For staff?
YES
NO
For locums?
YES
NO
For associates?
YES
NO
For cleaners and gardeners?
YES
NO
11.
Do you give written
Report of Findings and schedule of visits?
YES
NO
Are spouses/partners actively
invited?
YES
NO
12.
Do you send:
Birthday cards?
YES
NO
Welcome letters?
YES
NO
Thank yous or appreciation notes?
YES
NO
Thank you for referral cards
or letters?
YES
NO
Special occasion cards?
YES
NO
13.
Do you give Health
Care/Spinal Care/Special Appointment/Wellness Workshop
classes?
YES
NO
Are they integral for New Patient’s?
YES
NO
Do you request that your patients
bring a spouse/partner or friend/s?
YES
NO
14.
Do you have team
meetings at least every 2 weeks?
YES
NO
Do you use an agenda?
YES
NO
Do you regularly acknowledge
positive contributions by the team?
YES
NO
Do you keep personal correction
AWAY from the team meetings?
YES
NO
15.
Do your team members
wear uniforms?
YES
NO
Do your team members wear name
tags?
YES
NO
16.
Do you and your team
review appropriate scripting?
YES
NO
Do you and your team regularly
role play scripting?
YES
NO
17.
Do all your team
members have regular chiropractic care?
YES
NO
Do the family members of your
team have regular chiropractic care?
YES
NO
Do your family members have regular
chiropractic care including re-exams and re-xrays?
YES
NO
18.
Have you had your
insurance needs reviewed and adjusted by an insurance
professional in the last two years?
YES
NO
Do you have malpractice insurance?
YES
NO
Do you have personal sickness/accident
insurance?
YES
NO
Do you have a ‘Pension Plan’
in place that will provide for all your lifestyle
needs when you retire?
YES
NO
Do you use the services of a
qualified Financial Planner?
YES
NO
19.
Please
indicate if you are using the following forms:
Confidential Case History?
YES
NO
Daily Practice Statistics Log?
YES
NO
X-Ray Release?
YES
NO
General Patient Information Release?
YES
NO
Office Policy?
YES
NO
Arrival Register?
YES
NO
Written Report of Findings?
YES
NO
X-ray Log Book?
YES
NO
Initial Physical Examination?
YES
NO
Progressive Physical Examination?
YES
NO
Comparative Physical Examination?
YES
NO
Subjective Progressive Patient
Questionnaire?
YES
NO
Subjective Comparative Patient
Questionnaire?
YES
NO
Health Index Patient Questionnaire?
YES
NO
Automobile Accident Questionnaire?
YES
NO
Children’s Examination?
YES
NO
Recent Patient History?
YES
NO
Fee Schedule?
YES
NO
20.
Do you give each
patient an Emergency Care Card (i.e. patient’s vital
information for use when out of town)?
YES
NO
21.
Please indicate if
you are using the following:
One Write or Computer System?
YES
NO
Repairs Book?
YES
NO
Team Meeting Diary?
YES
NO
Telephone Message Book?
YES
NO
Communications Diary?
YES
NO
Library Loan Book?
YES
NO
Video Loan Book?
YES
NO
X-Ray Release Book?
YES
NO
Mail, Sent/Received Book?
YES
NO
22.
Do you regularly
attend:
Chiropractic continuing education
seminars?
YES
NO
Financial planning/investment
seminars?
YES
NO
Personal growth seminars?
YES
NO
Chiropractic Association Meetings?
YES
NO
23.
Are you actively
involved in at least one local community service,
school, sporting or special interest group?
YES
NO
24.
Do you regularly
read books associated with professional and personal
development, excellence or life principles, business
management or inspirational works?
YES
NO
25.
Do you take regular
holidays?
YES
NO
26.
Do you take at least
one full day per week away from the office?
YES
NO
27.
Do you participate
in a mentor program or Mastermind group?
YES
NO
28.
Do you have a clinic
newsletter at least 4 times per year?
YES
NO
29.
Do your staff attend
CA training seminars?
YES
NO
30.
Do you have special
staff appreciation days or evenings or do you reward
your staff with incentive/performance bonuses or special
gifts?
YES
NO
31.
Have
you personally or with your team identified at least
50 characteristics of your ideal patient?
YES
NO
32.
Do you have a written
statement of purpose?
YES
NO
33.
Do you have practice
Mission and Vision Statements?
YES
NO
34.
Do
you have written goals:
For your personal life?
YES
NO
For your practice?
YES
NO
For your financial future?
YES
NO
35.
Do you know what
your 'net worth' is?
YES
NO