Practice Appraisal Form Email* Enter Email Confirm Email Name* First Last What is your specialty?* How long have you been in practice?* Check the best description of your practice.*Medical Practice only, no aesthetics, adding body contouringMedical Practice, doing body contouring already, adding SculpSureMedical + Aesthetics (Face & Skin) already, adding body contouringMedical + Aesthetics (Face, Skin & Body) already, adding SculpSureMedical Spa (Face, Skin & Body), adding SculpSureMedical Spa (Face & Skin only), adding body contouringPlastic Surgery office with non-invasive body contouring, adding SculpSurePlastic Surgery office, offer non-invasive Face & Skin, adding body contouringPlastic Surgery office, offer non-invasive Face, Skin & Body, adding SculpSureWhich of the following best describes your practice location:*Multi-office Medical BuildingStrip Center with other medical officesRetail Strip CenterNeighborhood Strip CenterStand-alone Medical BuildingWhat is your anticipated or current role in the SculpSure practice? CEO, I know everything. Everyone reports to me CMO, I stay busy with my medical practice and limit my involvement to the medical director of the SculpSure practice Hands on, doing SculpSure Consultations Hands on, doing SculpSure Consultations and Treatments Hands on, direct involvement in development & management of SculpSure practice Hands off, I delegate my SculpSure practice success to another (check all that apply)Total # of staff members* Titles & Roles RN LVN MA Aesthetician Technician Office Manager Receptionist Telephones Customer Service (check all that apply)If you answered "Other", please describe title & role below.Who is or has been responsible for developing your SculpSure practice? Provide first name(s) and job title(s)*Who will be or is currently trained to talk about SculpSure? List all applicable first names with job titles.*Who will be or has been promoting your SculpSure practice? List all applicable first names with job titles and provide the name of any company you have engaged.*Who will do or has been doing the SculpSure Consultations? List all applicable first names with job titles.*What types of aesthetic procedures do you currently offer?*Which staff position at your office answers phone calls? List all applicable names and job titles.*Does your Front Desk answer phones?*YesNoDo you have a phone team, separate from the front desk?*YesNoWhat is your website address?* Check all current advertising:* TV Radio Print Ads In House Events Outside Events Groupon FaceBook Instagram Google Ads Billboards Native Bing Yahoo Digital Banner Ads Emails Direct Mail Other Who manages your marketing/advertising? Please provide name of company and/or staff member & title.*Who manages your website? Please provide name of company and/or staff member & title.*Describe the source of your SculpSure sales. Please provide estimated percentages. Current patient base vs New patients from advertising*or type N/A, if just purchasedWhat percentage of your current patient base has bought SculpSure already?* or type N/A, if just purchasedWho does your SculpSure Consultations? List first name(s) and job title(s).What are the 3 most common objections you hear from patients for not buying?or type N/A, if just purchasedWhat is your current SculpSure Consultation conversion rate? Provide your best estimate.* or type N/A, if just purchasedDo you have a sales follow up process, i.e. following up with Consultation patients who do not buy?*YesNoN/ADo you have a lead follow up system or protocol, i.e. patients who contact you in some way but do not schedule?*YesNoN/AWhat kind of SculpSure promos do you offer now, and have offered in the past?*or N/A, if just purchasedWho does your SculpSure treatments? Provide first name(s) and job title(s).*or type N/A, if just purchasedDo you routinely recommend “Treat to Complete” and require 2 treatments?*YesNoN/AWhat percentage of your SculpSure patients report being happy/satisfied? or type N/A, if just purchasedWhat are the top 2 reasons for patient dissatisfaction? You may list more than 2 if applicable.*or type N/A, if just purchaseDo you have a process for gathering patient Reviews/Testimonials?*YesNoN/ADo you have a process for identifying and posting your own Before and After photos?*YesNoN/AComments
