New Patient Appointment Observations Please enable JavaScript in your browser to complete this form.Observation Completed By *FirstLastDate *Patient's Name *FirstLastTeam Members Involved *New Patient Tour and Interview and X-raysNew Patient GreetingNew Patient Tour Comments Interview and FORE Minute Rule CommentsValues/Barriers addressed?Chief Concern?Accountability questionComments on verbiage used:How long did the x-rays take?Use of intraoral cameraPatient education/co-discovery (HYG only)Endorse the doctor before calling them into the room?Bluenote used correctly?Doctor Introduction, Handoff, and ExamIntroduction and Handoff CommentsDoes the doctor look professional (white coat, clothes, shoes, hair, makeup)?Chief complaint determined/addressedExam/Appointment VerbiageTriangle of influenceKnee to knee, eye to eyeTreatmetn options clearly presentedVerbiage used with presenting optionsDid the doctor use intraoral images when reviewing findings and presenting treatment?Treatment PresentationValues/barriers used to tailor treatment presentationAppropriate value created for treatmentWas a sense of urgency created?Did the doctor ask for an active commitment from the patient?Did the doctor use patient friendly words when discussing treatment? Any comments on areas for improvement in verbiage used?Did the doctor provide support/reinforcement about preventative care visits?Same day treatment offered if possible?Was the patient's chief concern addressed?Was their any minimizing or devaluing during the treatment presentation?How was the transfer of power to the treatment coordinator? Did the doctor endorse the treatment coordinator?Reviews and referralsHow long was the doctor in the room?Financial Presentation and SchedulingGreeting patient with a smile for handoffAppropriate handoff received? Did they ask any clarifying questions? Greeting patient with a simile for treatment presentationAppropriate handoff received? Asking how their appoiintmetn was (ENDORSE previous TMs/Doctors)Confirm today's appt/investmentUsing patients CBV to discuss treatment /scheduleDental WarrantyDual alternative for PIF or payment optionsDual alternative to schedule any apptScheduled: ASAP list? Not scheduled: follow up created 1) time of day 2) method to follow upValue/sense of urgency created for treatmentDo we need to schedule anyone else?Ask for review/referral/mention referral contest (ENDORSE)Case Acceptance Tracker utilized?Total duration:Any other comments?Submit
