PRACTICE KEY METRICS

Title *

First Name *

Last Name *

Email *

1. Number of Active Patients in the immediate past 18 months? *

An active patient is someone who has been to your practice at least once in the past 18 months-if they have come more than once please only count them once.

2. How many operatories are available to use your practice? *

Provide the total number of dental operatories that are fully equipped and available for use in your practice.

2.1 Remarks

3. Forward bookings – are patients booked in advance for recalls? *

If yes, how far ahead?

4. Number of new patients to practice in the past year *

Count of patients who attended your practice for the first time in the past 12 months (do not include returning or previously active patients).

5. Is your practice a preferred provider practice for any Health fund at all *

If yes, list the names of the health funds.

6. 2 years of Production figures

Provide the total production figures for the current financial year and the past financial year (e.g., 2024/2025). All figures must be provided in dollars ($) and in numeric format

Past Year Production *

Current Year Production *

Practice Item Codes Request

1. Last one year of Item Codes by Group performed in practice with fees invoiced *

Group item code report preferably Excel/csv format please

2. Last one year of Item Codes for each individual clinician at your Practice – (include OHT Hygienist if applicable with fees invoiced ) *

Individuals Item code report Excel/ csv format please

3. Operator names and hours per week / weeks per year

Please list every clinicians Initials, dentists / OHT / Hyg and hours per week - to calculate hourly rate for each clinician in the template provided

Practice Operators Data Template is added in your shared folder.

Probe Report

Registered Company Name *

Name of Practice *

ABN *

Street Address *

City *

State *

Country

Postal code *