Practice Evaluation Form

Practice Name*

Practice Owners Name*

Name Of Person Completing This Evaluation*

Practice Address*

Practice Phone Number*

Practice Owners Mobile Number

Practice Fax Number*

Practice Owners Email Address

How Did You Hear About Us*

Since Our Company Works On A Profit Sharing Arrangement, Are You Willing To Share Your Accountant Prepared Tax Documents With Our Firm So We Can Track Your Practice Growth*

Yes
No

What Type Of Practice Do You Have*

Is Your Practice In A Shopping Strip Or Free Standing*

Does Your Practice Offer After Hours Emergency Services*

Yes
No

What Type Of After Hour Emergency Service Does Your Practice Provide*

How Many Full Time Equivalent Veterinarians Are In Your Practice*

How Many Support Staff Does Your Practice Employ*

Does Your Practice Have A Practice Manager Or Hospital Administrator*

Yes
No

Give Us An Overview Of Your Practice*

Provide An Overall Description Of Your Practice Environment (Size Of The Market, Your Share Of The Market, Potential For Growth, Etc.)*

What Does Your Clients Believe About Your Quality*

What Does Your Clients Believe About Your Service*

What Does Your Clients Believe About Your Convenience*

Name Three Ways Your Practice Offers Great Customer Service*

Approximately, How Many New Clients Does Your Practice Get On A Monthly Basis*

Is Your Practice Computerized*

Yes
No

Does Your Practice Collect Email Addresses*

Yes
No

Does Your Practice Collect Mobile Phone Numbers*

Yes
No

Approximately, How Many Clients Are In Your Practice Database*

Approximately, How Many Clients Are Active Within The Last Two Years*

What Is The Biggest Struggle Your Practice Is Facing*

Has Your Practice Ever Hired A Consultant Before*

Yes
No

Describe Your Experience With Your Last Consultant (What Did You Like, What Did You Dislike, Did You Achieve Your Desired Results, Etc.)*

Approximately, What Was Last Year’s Gross Revenues*

Approximately, What Was Last Year’s Net Profit*

Approximately, What Is The Overall Average Client Transaction*

Does Your Practice Have Accounts Receivable*

Yes
No

Approximately How Much Is Your Accounts Receivable*

How Do Your Prices Compare With Other Practices In Your Service Area*

How Often Does Your Practice Increase Prices*

Does Your Practice Have An Overall Budget*

Yes
No

Please Describe Your Practice Budget*

Does Your Practice Offer Retail And Non-Prescription Food Sales*

Yes
No

What Percentage Of Gross Revenue Is Retail And Non-Prescription Food Sales*

Does Your Practice Currently Offer Some Services As Packages Or Bundles (Vaccinations, Surgery, Dental, Etc.)*

Yes
No

Please Explain How Your Practice Packages Or Bundles Its Products Or Services*

How Does Your Practice Currently Measure Compliance*

Who Is In Charge Of Marketing*

Does Your Practice Have An Existing Marketing Plan*

Yes
No

Please Describe Your Practice Marketing Plan*

Does Your Practice Have An Annual Marketing Budget*

Yes
No

Please Describe Your Practice Annual Marketing Budget*

Are You Getting A Good Return On Your Advertising Investment*

Yes
No
Not Sure

What Is Your Best Source Of New Clients*

How Often Does Your Practice Send Out Special Mailings, Alerts Or One-Time Offers*

What Has Been The Three Most Effective Offers Your Practice Has Used In The Past*

Does Your Practice Have A Telephone Script For Your Receptionists*

Yes
No

Out Of Ten Potential New Clients That Call Your Practice, How Many Will Become Clients*

Why Do You Think The Rest Of These Potential New Clients Do Not Become Clients*

Does Your Practice Have A System For Collecting Client Reviews Or Testimonials*

Yes
No

Please Describe How Your Practice Collects Reviews Or Testimonials*

How Many Client Testimonials Does Your Practice Currently Have*

Does Your Practice Have An Active Referral Program*

Yes
No

Please Describe Your Practice Referral Program(s)*

Does Your Practice Have An Active Reactivation Program*

Yes
No

Please Describe Your Practice Reactivation Program(s)*

Does Your Practice Have A System For Welcoming New Clients*

Yes
No

Please Describe How Your Practice Welcomes New Clients*

Does Your Practice Have A Special Way To Recognize Your Top Clients*

Yes
No

Please Describe How Your Practice Recognizes Your Top Clients*

Does Your Practice Have Systems In Place For Client Visits*

Yes
No

Please Describe What Systems Your Practice Has For Client Visits*

Does Your Practice Send Out Vaccination Reminders*

Yes
No

Does Your Practice Send Out Examination Reminders*

Yes
No

Does Your Practice Send Out Dental Reminders*

Yes
No

List Any Other Types Of Reminders Your Practice Sends Out

Does Your Practice Have A Website*

Yes
No

Practice Website Address*

Does Your Practice Website List The Practice Phone Number Prominently In The Header*

Yes
No

Is Your Practice Website Updated Regularly*

Yes
No

Does Your Practice Website Collect Visitors Information Through A Newsletter Or Special Sign Up Offer*

Yes
No

Does Your Practice Website Have An Automatic Email Message (Autoresponder) That Is Sent Out When Someone Signs Up*

Yes
No

Does Your Practice Website Feature Client Testimonials*

Yes
No

Does Your Practice Have A Mobile Website*

Yes
No

Does Your Practice Send Out A Newsletter*

Yes
No

How Often Is Your Practice Newsletter Distributed*

How Many Newsletters Does Your Practice Send Out With Each Mailing*

Does Your Practice Use Social Media (Facebook Fan Page, Twitter, LinkedIn, Etc.)*

Yes
No

Has Your Practice Claimed Its Google Places Listing*

Yes
No

Has Your Practice Claimed Its Yahoo Local Listing*

Yes
No

Has Your Practice Claimed Its Bing Listing*

Yes
No

Does Your Practice Use SMS/Text Message Marketing*

Yes
No

Does Your Practice Use Bluetooth Marketing*

Yes
No

Does Your Practice Use Any Unique Tracking Phone Numbers In Its Marketing Pieces*

Yes
No

List Any Other Advertising Methods That Your Practice Uses (Yellow Pages, Val-Pak, Community Events, Etc.)

Practice Evaluation Questionnaire

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