High Tech Consulting Questionnaire | Emmott On Technology

Name
Address
Address 2
City	State	Zip
Phone	Fax	E-mail (required)

Describe your situation
	Beginner Looking for a new system, need help choosing software, know little about computers and technology in dentistry.
	Intermediate Comfortable with computers, need help in choosing advanced systems, budgeting, treatment room placement and getting the staff involved.
	Advanced Already using some advanced systems, need help fine tuning and getting the most out of our investment.

When did you first computerize?

What Practice Management software are you using? i.e. Dentrix, Practice Works, Softdent etc.
Are you satisfied with it or are you looking to change?
Why?

How many employees and dentists are in the practice?
	Dentists
	Assistants
	Administrative
	Dental Hygiene
	Others?

How much experience does your staff have with computer technology?

Are they all using the computer now?

Yes No

Do you want them all to use a computer?

Yes No

Is the staff comfortable with computers or are they resistant?

Which of the following high tech systems are you using or plan to use?
System	We use it now	We would like to use it
Intra Oral Camera
Camera connected to the computer?
Cosmetic Imaging
Digital Photography
Digital Radiography
E-Claims
Patient Education
Remote Access

Do you have computers in the treatment rooms?

Yes No

Do you want to have computers in the treatment rooms?

Yes No

What are your goals regarding computer use in the practice?

What is the biggest problem you have using computers?

Which of the following Computer Technology components are you interested in knowing more about? Place a number rank 1-5 beside the 5 you are most interested in. Please select only 5 components.
	Budgeting	Implementation Plans
	Review Proposals	Paperless Charts
	Digital Radiographs	Front Desklessness
	Electronic Scheduling	Interoffice Communications
	Reports	Data Base Marketing
	Training	Electronic Claims
	Data Safety	Computerized Probe
	Patient Education	Off Site Access
	Digital Treatment Planning	Voice Commands
	Intra Oral Cameras	Contingency Planning
	Cosmetic Imaging	Internet
	Digital Cameras	Future Applications
	Treatment Room Design	Office Web Page

What do you really want the most from me?

After you have completed this questionnaire return it to me via mail or fax. Also send copies of anything else that may be important. For example a floor plan, sales proposals from vendors etc.