Address 2






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?


How many employees and dentists are in the practice?




Dental Hygiene


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?

We use it now
We would like to use it

Intra Oral Camera

Camera connected to the computer?

Cosmetic Imaging

Digital Photography

Digital Radiography


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.


Implementation Plans

Review Proposals

Paperless Charts

Digital Radiographs

Front Desklessness

Electronic Scheduling

Interoffice Communications


Data Base Marketing


Electronic Claims

Data Safety

Computerized Probe

Patient Education

Off Site Access

Digital Treatment Planning

Voice Commands

Intra Oral Cameras

Contingency Planning

Cosmetic Imaging


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.