Dr. Charles Ward Innate Legacy
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How Healthy Is Your Practice?
This process will be followed by a free 10 call With "Coach Charles E. Ward"
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Doctor's Name
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First
Last
Address
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Line 1
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City
State
Zip Code
Country
Email
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Work Phone
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Fax Number
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Cell Number
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Spouse
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Children
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place comma between names
Referred By
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Years In Practice
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1) Is your practice at its maximum new and weekly visit capacity?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points- No
2) Are you growing your practice by at least 5-10% or more per year?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
3) Do you currently have a 12 month marketing plan?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
4) Are you monitoring your return on investment on your marketing?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
5) Is your practice currently profitable?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
6) Do you currently meet with your team weekly?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
7) Do you have a weekly training program in place for your team?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
8) Are you witnessing an increase in your patient weekly patient visits?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
9) Do you currently use payment plans?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
10) Does your marketing include outside talks, referral programs, website?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
11) Do you currently re-invest more than 5% of your gross in personal and practice development?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
12) Do you implement progress/re-evaluation procedures to demonstrate change in patient’s overall well being?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
13) Are you currently performing a spinal care class to your new patients?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
14) Do you have family plans and wellness plans in place for your patients?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
15) Are you utilizing training, policies, systems, procedures, and leadership skills in the practice to decrease your stress, increase team morale, create an efficient, high energy, mission based office having more fun?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
16) Are you currently performing daily rituals of exercise, affirmations and nutrition to create an abundance of energy and mental focus?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
17) Have you created a 5, 10, 25 year dream and goal list to be, do, have more in life?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
18) Do you have a consistent patient education system in place?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
19) Are your patient’s spouses attending the Report of Findings?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
20) Are your CA’s enthusiastic and excited about serving more people?
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Yes
No
Points
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Please Select
5 Points - Yes
0 Points - No
Total Score
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Please provide the following information to help us better serve you
1. Do you currently have a coach to help you create the practice of your dreams and an extraordinary quality of life?
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Yes
No
2. If you were to easily add 10-20 more new patients in a month, would you make an emotional commitment to make the changes needed to achieve these growth targets?
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Yes
No
3. If I continue with my practice in the direction it’s going, I’ll be financially independent in 3-5 years.
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Yes
No
4. Is a lack of new patients, income, life balance affecting your joy in practice; ability to do and have more in life, plan for retirement, provide the best for your children?
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Yes
No
How can we best help you as a coach?
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6. What is the number of hours you currently work weekly?
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7. How many new patients do you see on an average per month?
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What would you like to work weekly?
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8. What is the number of weeks vacation you’ll take this year?
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9. What is the number of weeks vacation you’d like to take each year?
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10. How much would you like to increase your net practice income in the next 12 months?
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11. What Chiropractic technique(s) do you use in your practice?
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Would you like more information regarding Innate Legacy emailed to you?
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Yes
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