Existing Patient Appointment Observations Please enable JavaScript in your browser to complete this form.Observation Completed By *FirstLastDate *Patient's Name *FirstLastTeam Members Involved *Patient Greeting and X-raysPatient GreetingFORE Minute Rule ChangesTWO (Time, Woo, Over the Moon)Values/Barriers *Changes*Chief Concern TodayComments on Verbiage UsedHow long did the x-rays take?Use of intraoral camera?Unscheduled treatment addressed?New tx pt education co-discovery (hyg only)Endorsing doctor prior to doctor entering treatment roomBluenote used correctly?Handoff to DoctorDoctor Introduction, Handoff, and ExamDoes the doctor look professional (white coat, clothes, shoes, hair, makeup)?Introduction and Handoff CommentsChief concern determined/addressed?Unscheduled treatment addressed?Exam/appointment verbiageTreatment PresentationTriangle of Influence/Doctor sitting knee-to-knee eye-to-eyeDid the doctor use patient friendly words when discussing treatment? Any comments on areas for improvement in verbiage used?Did the doctor use intraoral images when reviewing findings?How did the doctor create value for treatment? Were the patient's values and barriers used during the treatment presentation?Was their any minimizing or devaluing during the treatment presentation?Was a sense of urgency created?Did the doctor ask for an active commitment from the patient?Did the doctor provide support for preventative care visits?Was the patient's chief concern addressed?Was unscheduled treatment addressed?How was the transfer of power to the treatment coordinator? Did the doctor endorse the treatment coordinator?Did the doctor ask for a referral?Were the treatment needs clearly presented for did the patient seem confused by the plan?How long was the doctor in the room?Financial Presentation and SchedulingGreeting Patient with a smile for handoffHow as the handoff received?Did they ask any clarifying questions?Greeting Patient with a smile for tx presentation/in room checkoutAppropriate handoff received? Asking how their appointment was (endorse previous TMs/Doctors)Confirm todays appt/investmentUsing patients CBV to discuss treatment/scheduleDental WarrantyDual alternative for PIF or Payment OptionsDual alternative to schedule any appt Scheduled: 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)Was the case acceptance tracker utilized?Total DurationDid the patient leave on time? What are suggestions for improvement to make the appointment flow faster?Any other comments?Submit
