PRACTICE QUESTIONNAIRE
CLINIC HOURS
(Please Indicate any break for lunch)
NAMES OF TEAM MEMBERS
Include job title and years of experience
CLINICAL TEAM
TREATMENT
CLINICAL MANUAL
CHARTING
TREATMENT PLANS
SET UPS
TRAY LINERS
SUPPLIERS
BANDING/BONDING
APPLIANCES
ELASTICS
RETAINERS
EMERGENCY APPOINTMENTS
UNIFORMS
STERILIZATION
VERBAL SKILLS
CHAIRSIDE STORAGE
ORDERING
EXTRA DUTIES
CONTESTS
EDUCATION PROGRAMS/SCHOOL PROGRAMS