Cyberconsulting Page 1 CYBERCONSULTING (If you see a P it was where a chreck off box was) Dr. Joel E. Margolies Your answers will be kept confidential and should be answered honestly. As a disclaimer .. I am attempting to assist you and your staff to increase office and community awareness of chiropractic. The results will be up to you and your staff. If you intend on participating with this program you will be sent a new lesson each week for ten weeks. I expect an e- mail response the day after it is sent .. you will have a new one each Monday .. the response should include who is responsible for the implementation of the new lesson and the results of previous week. These weekly lessons may be at a speed either too fast or too slow for you .. remember that I am sending these to various doctors with various levels of experience and years in practice. Save these lessons and do what you can and keep going. In order to make it a sane endeavor for me .. I ask that you e-mail me any questions and stops to implementation after careful thought on your part and what you would recommend if the roles were reversed. The best teacher is the wee voice within .. now begin listening This should be completed by the doctor Name: Years in Practice: Address: Phone: Fax: E-mail: Chiropractic College Graduated From: Year: Have you taken other Practice Management Programs: p Yes p No Which One(s): ______________________ ______________________ Are You Presently: p Yes p No What was the most beneficial things you learned from it? ______________________ ______________________ ______________________ ______________________ What was the things you disliked the most? ______________________ ______________________ ______________________ ______________________ Were you unable to implement all they said to do? p Yes p No If yes ... what personal stops did you find? (where were you unable to follow through) ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ In terms of your present business sense .. where do you find yourself weakest? Where do you find yourself the strongest? ______________________ ______________________ ______________________ If you were an objective consultant .. consulting someone like yourself .. what would you ask this person to do to achieve and succeed more? ______________________ ______________________ ______________________ If you were an objective consultant .. consulting someone like yourself .. what areas would you work with to achieve and succeed more? ______________________ ______________________ ______________________ If you were an objective consultant .. consulting someone like yourself .. who in the office would also have to increase their base of knowledge to achieve and succeed more? ______________________ ______________________ ______________________ If you were an objective consultant .. consulting someone like yourself .. where do you see the stops to progress in this office? ______________________ ______________________ ______________________ If you were an objective consultant .. consulting someone like yourself .. what areas of practice management would have to change to achieve and succeed more? ______________________ ______________________ ______________________ If you were an objective consultant .. consulting someone like yourself and after review of the present knowledge of the doctor and staff where does immediate help need to be? Doctor: ______________________ ______________________ ______________________ Staff: ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ Have you found the blocks in: New Patients: _____________________________ ___________________________ Retention of present patients: ______________________ ______________________ Practice Management (money etc.) ______________________ ___________________ Your office in a p Shopping Strip p Self Standing Bldg. p Professional Bldg. p Other Do you feel the size of your office is too p Big p Small p Not a factor Do you feel the location is p Okay p Problem p Not a Factor .. If a factor .. What would you change? ______________________ ______________________ Has fees and/or asking for money been a problem for you? p Yes p No If yes please describe: Staff: How many full time ______ part time _______ As needed ________ Names and responsibility: _________________________ does ____________________ _________________________ does ____________________ Is anyone cross trained? _________________________ does ____________________ Do you have regular staff meetings? p Yes p No How often? In general does these sessions p Help p Make No Difference p Accepted by Staff To implement any marketing ideas what would be some roadblocks for you? p money p fear of rejection p fear of public speaking p inability to present proposal Is your office close to a local college? p Yes p No Could you afford and hire someone for Public Relations and Marketing? p Yes p No Are any members of your staff on a bonus system p Yes p No If yes please describe: This consulting program have you work closely with your staff to advance awareness both within and without your office for the benefit of chiropractic and your community. Are you willing to: Re-evaluate your staff: p Yes p No Have close staff meetings: p Yes p No Implement programs that may feel beyond your comfort zone: p Yes p No Train someone to do what you feel uncomfortable doing: p Yes p No Have access to my homepage or e-mail only? p Homepage and e-mail p e-mail only Do you have my Smart Start Textbook? p Yes p No CAžs Marketing and Public Relations Book? p Yes p No Smart Start Disk? p Yes p No Does your computer use: p Windows p Macintosh If you wish to participate in this Cyberconsulting Program complete and send this survey to the address below. A non refundable check of $150 should accompany this survey the remaining $350 must be sent between the first five weeks of this ten week program. If you wish to withdraw from this program all fees not used will be returned to you except the initial three weeks ($150). You may use a charge card by completing the information below or call our office with the number. The Smart Start Book is 242 pages jammed with Practice Management and Public Relations programs, including scripts for both you and the staff. I will be referring to the pages week by week. The retail fee for this book is $59.95 and sold by various vendors. The cost of this book for my Life University students through the bookstore is $35 and will be your fee. The CA book is an optional text that has many of the same ideas but has enough new ones to warrant it being in your library. It is recommended that you purchase the Smart Start Book. The Smart Start Disk is used in conjunction with the book .. many of the text for various programs are in it and can be used by removing my letterhead and replacing it with yours .. as well as changes can be made. It is sold for $25 retail and $15 to the Life students .. which will be your fee. This is optional as well. Action Steps: 1: Complete and send this survey today 2: Send a non refundable check of $150 with the survey or compelte the credit card info 3: Send a check or complete the credit card information for fees and/or textbooks 4: If possible (even at a later date) send a picture of you and the staff with names If you wish to participate send this survey to the following address: Dr. Joel E. Margolies 4910 LaVista Road Tucker, Georgia 30084-4403 770-491-3639 (voice) 770-491-3799 (fax) e-mail: joel3639@aol.com Homepage: http://www.mindspring.com/~chirosmart Fees: Check the product and amount you are paying or wish us to bill to your credit card p Smart Start Book $35 p CA Marketing Book $35 p Disk $15 p $150 (initial fee and non refundable .. first three weeks) p $500 (entire program) Name on Card: ___________________________ Signature: _______________________ Type of Card: p AMX p MC p VISA p DISCOVER # ______________________________________________ expires ________________