Team Member Questionnaire

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Company Name*
Your Name*
First Last
Email*
Photo Upload
Max. file size: 8 MB.
How did you get into dentistry?*
Years in dental field*
Years of Service with Practice*
Position*
What continuing education and/or professional development courses have you taken in the last 12 months?*
Have you ever taken any type of test that’s tells you about your personality and/or leadership style?
if yes please share
What attracted you to work with this company?*
How would you compare this company to former companies you have worked in?*
What do you love about your owner/boss?*
What do you wish your owner/boss would start doing?*
Without honesty there is no opportunity for change!
What do you wish your owner/boss would stop doing?*
Without honesty there is no opportunity for change!
How do you feel about the leadership in your company?*
As stated before, without honesty there is no opportunity for change!
Name something that would help you do your job better*
What type of long term goals do you professionally and personally have set for yourself?*
What type of short term goals do you professional and personally have set for yourself?*
What is the one goal that you would like to professionally challenge yourself with next year? What type of support can the company provide you with that would make you feel supported?*
Name 3 specific moments or events this year with the company that your most proud of.*
I feel the practice should have the most focus on....*

Order of importance from your perspective
If you feel that there are some team members that might not be on board with your doctor's vision for the practice, please express your concerns here WITHOUT providing names. I would never want you to feel that you’re ratting your team members out by simply giving you a private platform to express your opinions.*
Share a few customer stories that touched our heart this year .*
What would prevent you from being with this practice long-term?*
Do you feel you are in the right position in this practice? If no, where would you feel you were best suited?*
Tell me about your personality*
- Dominate
- Influencer
- Systematic
- Conscientious
Select One
How do you learn and retain information best?*
What areas of the office do you feel you would like to have more training on?*
Have you ever had a coach before or been in a practice with a coach? What type of experience did you have and did you find any value in the process?*
What would prevent coaching from being beneficial for you? For the company from your perspective?*
How would the training you are interested in support the company's vision and your personal goals?*
Please name a few of your favorite things (i.e candy, food, treats, sweets, snacks and drinks!)*
How many hours per day are you on social media and what is your favorite platform?*
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Team Member Questionnaire

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