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The Mastery of Business, Marketing & Practice

UltimatePractice.com


Introduction Strategize, Customize, & Implement!

We are a chiropractic consulting and practice management company, unlike any other. We do more than just “coach� you - we get results by providing personalized attention and customized strategies to help you strategize, customize, implement, and analyze your business. Our commitment is to exceed your expectations and help you be successful.

You Run a Practice, You Own a Business!

Ultimate Practice was founded as an innovative approach toward building a practice through coaching, practice analysis, seminars, and personalized practice and business management. Managing and planning for the future requires working smarter to make your business run with less effort and higher profitability.

Our Core Beliefs

Our philosophy is that success is good management in action and your success is attainable through your dedication to improving your technical, management, business, and leadership skills.

~ Our Commitment ~ We will strive to exceed your expectations as your personal coach and help you be successful in your practice. We will help you create results through customized strategies based on your personal practice needs. Together, no obstacle is too big.

UltimatePractice.com


Meet the Coach CURRICULUM VITAE - DR. TIMOTHY J. GAY A LIFELONG COMMITMENT TO CHIROPRACTIC “With so many changes in our profession and the advancements being made in chiropractic, we are at a crossroads in our profession. I plan to continually learn the latest methods, procedures, and technical data to contribute to health care, chiropractic, and my colleagues.”

“We strive for your success. Together ~ no obstacle is too big.

Graduate:

D.C., Palmer College of Chiropractic - Davenport, IA Continuing education classes taken annually

Member:

Washington State Chiropractic Association (Past District 1 Board Member) California Chiropractic Association (San Diego Chapter Board Member) New Mexico Chiropractic Association International Chiropractic Association Chiropractors on the Road to Excellence (CORE) Chiropractic Knights of the Round Table International

USING HIS EXPERTISE TO HELP PEOPLE AROUND THE WORLD “I believe it’s important to share what I’ve learned. My articles, lectures, and classes give me the opportunity to help people live life to the fullest. That is the goal of what we teach and communicate to our colleagues. Licensure: • State of California, Washington State, State of New Mexico Lecturer & Guest Speaker:

Presented to variety of Chiropractic Audiences: • Life Chiropractic College West • Parker Seminars • Life Seminars - LP3 Georgia • Southern California University of Health Sciences - Whittier, CA • WA State Chiropractic Association; WA State Success Council; WA State Philosophy Forum • Ultimate Practice educational seminars on Practice Management • Marketing and Advertising, C.A. Training, Ultimate Associate Program, and more • California Chiropractic Association • New Beginnings - Eatontown, NJ • Durch Chiropractic Federation, Amsterdam, the Netherlands

Author:

Published articles in chiropractic publications: • Chiropractic Economics • CCA San Diego Chiropractor • Plexus • The Chiropractic Journal • The American Chiropractor

HONORED BY THE PROFESSIONAL COMMUNITY “Being honored by other professionals is exciting. It shows that they truly value my work and my contribution to the chiropractic profession.” Voted: Serving:

• Washington State Chiropractor of the Year 1991 and 1999 • Chiropractic Sentinel Award - 2000 • California Chiropractic Association President’s Award for Excellence and Mastery - 2006 • California Chiropractic Association Chiropractor of the year 2007 • CCPAC/CCIPAC Committee/Department of Governmental Affairs District Director • CCA Dept. Chairperson/Dept. of Member Services 2007 - 2008 • CCA Co-Chair of the Marketing and Communications Committee 2010 - Present • CCA Nominating Committee Member 2010 - Present

DONATING HIS TIME TO HELP THE CHIROPRACTIC PROFESSION “There are thousands of people around the country who face terrible pain every day. I want to do my part to help make them feel well again. That’s why I’m actively involved in these important national groups. I feel by helping chiropractors I am helping more patients as well.” Creator:

• Chiropractic Health Information Program - Nationwide • Back Pack Safety Coalition - Nationwide • Chiropractors on the Road to Excellence - San Diego, CA (CORE)

866.797.8366


Testimonials

“I’ve been working with Dr. Gay since 2004 and have seen my practice grow, and continue to grow... He’s probably one of the greatest chiropractors still living.”

~ Dr. Bart Conn

“Dr. Gay has been there for me, he’s been there for my staff, and every single time I’ve needed him he’s been there for me.” ~ Dr. Mary Azim

“Since joining Ultimate Practice I have seen my practice grow with success. I appreciate everything Dr. Gay has done to help with my success as a chiropractor and a person... I recently purchased my own building!” ~ Dr. John Sim

“I’ve been a client of Dr. Gay’s for a number of years now and I have shown a tremendous amount of growth from his leadership. I use Dr. Gay as my compass to keep me in the direction that I want to go for the growth of my practice.” ~ Dr. Dave Lemmon

“I signed up with Dr. Gay 2 years ago... My practice has now quadrupled, both in size and finance.” ~ Dr. Alice Chalikian

UltimatePractice.com


10 Reasons Why

Here Are Some of the Features and Benefits of Becoming an Ultimate Practice Member! 1.

A Personal and Professional Advisor Assigned to Deliver Customized Attention

2. Providing Unlimited Toll-Free Telephone Support (866.797.8366) 3. Bimonthly Communication: E-mail and Phone Calls 4. Emphasizing Strength, Power, and Belief in the Purpose of Your Practice 5. Delivering a Personal Practice Profile Assessment 6. Effective Practice Systems Developed Exclusively for Your Practice 7. Analyzing Your Statistical Information Weekly 8. Having Your Own Professional Training Manuals, CDs, DVDs, and Seminars 9. Dynamic Marketing Information at Your Fingertips 10. Increase in Patients and Income While Decreasing Overhead and Stress! If you’re not having as much fun healing and helping patients as you once did because of trends, insurance reimbursements, HMOs, and competition in the marketplace, it’s time to call Ultimate Practice! Our clients, doctors just like you, have experienced a substantial transformation in their practice and in their lives.

“I’ve been working with Dr. Gay since 2004 and have seen my practice grow, and continue to grow... He’s probably one of the greatest chiropractors still living.” ~ Dr. Bart Conn Following a practice evaluation, we develop step-by-step action plans that are simple yet unique. With our innovative one-on-one conference instruction and actual visitation of your clinic, we help you achieve your goals and accelerate your growth potential.

Call Ultimate Practice for Your FREE Practice Analysis!

866.797.8366


Making the Decision If you’re in search of making your practice more profitable, enjoyable, and rewarding, make the decision now to become a member of Ultimate Practice. Don’t let indecision be the worst decision you make.

Ask Yourself 1.

Am I currently seeing as many patients as my clinic can accommodate?

YES NO

2. Is my practice at its capacity?

YES NO

3. Does my practice have more than 100 patient visits per week?

YES NO

4. Has my practice steadily increased?

YES NO

5. Is my desk clear and free of paperwork?

YES NO

6. Do I have the perfect staff and/or Associate with no issues?

YES NO

7. Does my office run as smoothly as it should day to day?

YES NO

8. Am I stress-free when it comes to managed care, insurance and/or practice obstacles?

YES NO

9. Am I reimbursed by the insurance companies for my services?

YES NO

10. Is my profit margin high and overhead low?

YES NO

11. Are my marketing strategies bringing in as many new patients as I want?

YES NO

12. When a patient stops treatment, do I know the reason why?

YES NO

13. Do I have a clear vision of what I want out of my practice in the next year?

YES NO

14. Do I have a philosophy and mission statement for my practice?

YES NO

If you answered “no” to any of these questions, there is room for improvement in your practice.

We Can Help.

How We Can Help

Call today for your FREE Practice Analysis 866.797.8366

Proven systems and a trusted coach are fundamental for reaching the next level of your success. Our program is designed to get to the heart of your practice by providing solutions for your individual needs through sound advice, personal support, and the systems necessary for creating your ultimate practice.

UltimatePractice.com


Training Materials Ultimate Marketing & Advertising Guidelines Thorough and effective internal and external marketing strategies for attracting new patients.

Ultimate Procedures, Protocols, & Practice Management Ultimate Guidelines for patient and employee management, procedures, and protocols for building your practice. Insurance reimbursement, financial plans, and clinic forms are included.

Price: $199

Price: $199 The Ultimate Associate Program Creating, developing, and duplicating a multiple-doctor practice. Everything you need to know about Associates.

The Indispensable Chiropractic Assistant Manual Explains the history of chiropractic, the importance of attitude and image, complete job descriptions, expectations and essential procedures with effective scripts.

Price: $199

Price: $199

Please fax completed form to: 760.736.9335 Chiro-Practice Introduction Pack $99

Ultimate Procedures, Protocols, & Practice Management $199

Office Procedures $199

The Indispensable Chiropractic Assistant Manual $199

Art and Philosophy of Chiropractic V1 and V2 $299

Ultimate Marketing & Advertising Guidelines $199

The Greatest Hits of Marketing $299 Pack

The Ultimate Associate Program $199

Poster Pack $199

Quick Reference Tools $60

Speaking Engagements $299 Pack $49 per Speaking Engagement Backpack Safety

Stress Management

Fibromyalgia

Injury Prevention (Work Safety)

Headache Pain

Personal Injury

Spinal Health Care

Ergonomics and You

Carpal Tunnel Syndrome

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Credit Card Number: ____________ - ____________ - ____________ - _____________ Expiration Date: _________ / _________

CCV: _____________

Name as it appears on card: ______________________________________________________________ Billing Address: _________________________________________________________________________ Total Price: ________________ Shipping information will be provided to you before product is shipped. Authorized Cardholder Signature _______________________________________ Date: ______________

866.797.8366


Training Materials Chiro-Practice Introduction Pack Includes 4 discs of valuable introduction information including Patient Introduction, “That Something,� Practice Solutions 1, and Practice Solutions 2 to help you create a successful practice.

The Greatest Hits of Marketing Includes the 15 best external marketing secrets to make your business a hit, ways to motivate your staff and implement strategies that are simple and inexpensive, and provides marketing procedures that will create long term patients.

Price: $99

Price: $299

Office Procedures Includes teaching templates designed to create long-term patients, step-by-step procedures to help you customize your own programs, and DVDs designed to help both doctors and their CAs to perform their best.

Speaking Engagements Includes PowerPoints to use at speaking engagements: Backpack Safety, Injury Prevention (Work Safety), Spinal Health Care, Stress Management, Headache Pain, Ergonomics and You, Fibromyalgia, Personal Injury, and Carpal Tunnel Syndrome.

Price: $199

The Art and Philosophy of Chiropractic Learn about the Law of Attraction, Visualization creates Realization, and Laws and Properties: Building a Big Practice. Featuring Speakers: Dr. James Sigafoose and Dr. Timothy Gay. 12 hours of philosophy - DVDs + CDs (Video and Info) Price: $299

Build your Practice with these

Powerful Training Materials! Purchase Practice in a Box and save $700.00!

$49 each or $299 for the entire pack of 9!

Poster 8 Pack - Includes 8 print-ready posters for you to use in your practice Proper Functioning Spine, Cycle of Dis-Ease, 33 Principles, Strategic Poster Set, Chart of Effects, Subluxation Poster, For I Am a Chiropractor, Compass of Health. Price: $199

Quick Reference Tools Our Quick Reference Tools have been labeled as indispensable by our clients. These very inexpensive flip book tools are a great reference for not only employees, but doctors as well. Quickly define how to handle the most common situations known to take place on a daily basis in a chiropractic office. Price: $60

UltimatePractice.com


Coaching Benefits of Having a Coach

There is no time like the present to start receiving the benefits of a personal coach. The sooner you decide, the closer you will come to where you want to be in your practice. The only question remains: are you committed to taking the steps necessary to implement strategies and systems that will fulfill your needs and grow your practice? All of the procedures, protocols, management ideas and personalized training means little unless you are willing to take the necessary action. There are countless benefits of having Ultimate Practice assist you in everyday aspects of practice. We help you help yourself in the areas that need growth and improvement in your clinic. See for yourself...

We help you improve and increase your...

• • • • • • • • • • • • •

New Patient Flow Collections and income Insurance reimbursements Referral base Strength, power, and belief in your vision Patient compliance Community outreach efforts Staff relations and team motivation Patient communications Management by statistics Decreased overhead Increased profit Lowered stress levels

We help you develop solid...

• • • • •

Marketing plans Patient education programs Patient retention programs Patient management skills Efficient office systems and procedures

Membership Benefits...

• • • • • • • • • • • •

A personal and professional consultant Toll free telephone support Educational seminars Personal communications (by email, phone, and fax) Professional training manuals and CD ROMs Regular statistical analysis Community outreach efforts Personal practice profile Dynamic internal and external marketing strategies Effective practice systems, procedures, and protocols Regular review for stopgaps that slow practice growth Applied personalized business and practice training

There are too many areas of practice management to list here. If you have a particular area of need we didn’t mention, please call us and inquire as to how we can assist you.

Can You Afford A Personal Coach?

Absolutely! No matter where you are in your practice, you CAN afford a personal coach. How? Realize that it takes only one new patient per month to pay for a year membership. The best part is that you’re guaranteed to obtain that one patient per month and more! Now ask yourself, “Can I afford NOT to have a personal coach?”

Even the Best Athletes in the World Have a Coach. So Can You!

866.797.8366


On-Site Mastery Every doctor’s clinic is different - a ready made “recipe” approach to solving your clinic’s challenges

does not allow you to address your specific needs and challenges. The right way to offer advice for a solution with so many variables is on an individual basis. Choose from our variety of visitation assessments to personalize your clinic’s needs and jump-start your clinic’s journey of growth and transformation.

1 Day Training Schedule An onsite visitation of your practice, which includes a walkthrough of your clinic, both interior and exterior, taking photographs, and making assessments of each room and area of the clinic. A thorough personalized report is compiled from the assessment with explanations and suggestions for improvements to your practice.

Call for more details on payment schedule and information. 3 Day Training Schedule Day 1: An onsite visitation of your practice, which includes a walkthrough of your clinic, both interior and exterior, taking photographs, and making assessments of each room and area of the clinic. A thorough personalized report is compiled from the assessment with explanations and suggestions for improvements to your practice. Also, identifying areas of improvement within your daily procedures including protocols for front desk, consultation, examination, x-ray, and ROFs. Day 2: Improving staff management with personalized staff interviews to determine strengths and weaknesses. Also, a statistical practice analysis of equipment, hard overhead, soft overhead, and financial practice collections. Day 3: Streamline insurance and billing procedures. Create practice efficiency and effectiveness.

Call for more details on payment schedule and information. 5 Day Training Schedule Day 1: An onsite visitation of your practice, which includes a walkthrough of your clinic, both interior and exterior, taking photographs, and making assessments of each room and area of the clinic. A thorough personalized report is compiled from the assessment with explanations and suggestions for improvements to your practice. Also, identifying areas of improvement within your daily procedures including protocols for front desk, consultation, examination, x-ray, and ROFs. Day 2: Improving staff management with personalized staff interviews to determine strengths and weaknesses. Also, a statistical practice analysis of equipment, hard overhead, soft overhead, and financial practice collections. Day 3: Streamline insurance and billing procedures. Create practice efficiency and effectiveness. Day 4: Planning and creating internal and external marketing programs. Day 5: Refining and putting it all together for immediate and long-term goals.

Call for more details on payment schedule and information.

UltimatePractice.com


Training Materials

Everything You Need

to administer a successful practice! Your Price $997 Plus 1 month of FREE coaching.

A value of $1,697 Included with your Gold or Platinum membership

Practice in a Box

It’s as simple as plug-and-play. Practice in a Box is a resource center for everything you need to create a profitable practice. It contains marketing and advertising, associate training, procedures and protocols, and staff training manuals in excess of over 1500 pages of information. It also includes several posters used specifically for training and education of patients, 12 PowerPoints on various subjects and over 30 hours of DVDs and CDs that are designed to not only give your practice a strong foundation, but to utilize tools and resources to hire, train, and build the ultimate successful staff. This box also contains many legal and business documents you WILL need throughout your continuous years of successful practice to come. This is your Ultimate Practice building resource!

Introducing the newest innovation in portability.

The Practice Key

$497

Plus 1 month of FREE coaching.

Included with your Gold or Platinum membership.

Take the Practice Key with you on your key chain and have all the information included in Practice in a Box, now at your fingertips. Not only more portable, but more affordable. The newest innovation from Ultimate Practice. Creating new and better ways to build, market, and make your business more profitable. The Practice Key contains everything that comes in Practice in a Box downloadable from our Mastery website. Each key has its own encrypted password and code making it your personal key to start your practice and revvvv it up!!

866.797.8366


COPYRIGHTED MATERIAL This agreement acknowledges and binds the Member whose name and signature is below to the following terms and conditions. As a Member that receives copyrighted materials developed and distributed by Ultimate Practice to Members, I agree that I will NOT copy, reproduce, distribute, or share in any way the copyrighted printed materials, videotapes, CDs or other mediums I have received from Ultimate Practice. Additionally, I understand and agree these copyrighted materials are strictly for the use of my chiropractic clinic’s paid employees for the sole purpose of information and education. I further agree to hold Ultimate Practice and Ultimate Practice employees harmless from any liability related to the purchased materials. I agree that I am solely responsible to check with my individual state chiropractic licensing board and state laws pertaining to the content, legality, and implementation of these materials. I acknowledge and agree in advance there is no claim made as to the legality of content of the purchased materials and that the materials are for informational purposes only. Furthermore, I agree there is no claim made or guarantee as to any results or outcomes from the purchased products. Federal and California state law provides severe civil and criminal penalties for the unauthorized reproduction, distribution, exhibition of copyrighted materials, videotapes, CDs, or any other medium. Criminal copyright infringement is investigated by the F.B.I. and may constitute a felony with a maximum penalty of up to five years in prison and/or a $250,000.00 fine. I have read, understand, and agree to the Copyright Agreement: Member’s Signature: ____________________________________________________ Date: ________________________ MEMBERSHIP AGREEMENT TERMS Member shall receive a 15% discount if paying this Agreement in full as noted in the yearly fee total. • Gold or Platinum Member may attend any of Consultant’s intensive training at no additional charge. Member (and any staff or associates) are responsible for their own travel, lodging and related expenses in attending any/all of Consultant’s training. • All training sessions will take place at times and at locations as Consultant shall designate. • Member agrees to send Consultant any/all statistical information or records upon request. • Member understands that this is an intensive program and participation in all of Consultant’s services is strongly encouraged. The materials, methods, and practices presented at each training seminar are highly valuable and essential to the program. Member understands that he/she shall be responsible for the seminars or Member’s utilization of Consultant’s full services during the term of this agreement. • This Agreement shall be construed and governed in accordance with the laws of the State of California. Member agrees and acknowledges that the courts shall have exclusive jurisdiction to hear and determine all actions or suits which may arise from this agreement and Member and Consultant shall be subject to such jurisdiction. Both Member and Consultant waives his/her right to trial by jury. • In the event that any monthly installment payment is over ten (10) days late, a $25.00 administrative collection expense shall be added to that month’s balance due, and any/all such expenses shall be paid by Member. At Consultant’s option, Consultant may withhold all services that would otherwise be provided to Member until any balance that is outstanding for more than 45 days has been paid in full to Consultant. Consultant may, at any time thereafter, declare member in default and require the remaining balance for the term of this Agreement be accelerated and due and owing to Consultant. Member shall pay interest on all unpaid balances at a monthly rate of 5%. Any/all collections expenses for late payment of installments, if Member is declared in default, including reasonable legal costs and court fees, shall be paid by Member. This Agreement together with the terms on the reverse here of, to the extent applicable represents that entire Agreement and any/all prior agreements between parties, whether written or verbal are hereby null and void. • Member understands that monthly installments will be withdrawn on the first (1st) or fifteenth (15th) of each month dependant upon Member’s start date. • Member agrees to maintain service with us for your Agreement Term. Cancellation Policy: This is a contract and may not be cancelled during the Agreement Term. Consultant may, at any time, declare member in default and require the remaining balance for the term of this Agreement be accelerated and due and owing to Consultant. A written 90-days notice of cancellation is required for all agreements. • This Agreement is binding upon the parties hereto and their legal heirs, successors and assigns. • This Agreement begins on the date signed by Member. I have read, understand, and agree to the Copyright Agreement: Member’s Signature: ____________________________________________________ Date: ________________________

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Credit Card Number: ____________ - ____________ - ____________ - _____________ Expiration Date: _________ / _________

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Name as it appears on card: ______________________________________________________________________ Billing Address: _________________________________________________________________________________ Authorized Cardholder Signature: _____________________________________________ Date: __________________


Live Events We offer a variety of seminar topics throughout the year for the purpose of sharing with Doctors and their staff the knowledge and tools that have been time-tested and proven to be successful in practice. Topics may include staff training, practice management, marketing and advertising, patient management, insurance billing, and motivation. Seminars fees are included in most membership packages, however you do not have to be a member to attend our seminars. Call today for registration information, pricing, and a full schedule.

Guidelines To An Ultimate Practice

This comprehensive series of seminars encompasses all essential areas of building and maintaining your practice. Each session is different from the others and will focus on specific guidelines of practice procedures, patient management, marketing for new patients, staff training, and insurance coding and reimbursement. Each seminar is packed full of ideas, techniques, and tips that are effective and realistic to implement in your practice immediately.

Ultimate Practice Procedures, Techniques & Patient Management

The ultimate seminar to learn about practice management and earn CE credits. Correlate chiropractic philosophy and certainty to success in practice. Bullet proof your chart noting against insurance harassment. Create lifetime patients during the consultation, examination, and x-rays. Compare and contrast Thompson/Diversified/Gonstead techniques for cervical, thoracic, lumbar, and pelvic adjustments. Get results you and your patients deserve with strong recommendations.

The Indispensable C.A.

A practice cannot function at its best without a motivated and trained C.A. behind the front desk. Taking the C.A. beyond “just a job” to peak performance that benefits the team, the practice, and the patients. This program is a thorough scope of C.A. training and focuses on enhancing the C.A.s knowledge of a complete job description including essential practice enhancing procedures, effective communication with patients, and keeping the clinic running on schedule.

Chiropractic Business Mindset

At this powerful seminar learn what it takes to not only administer a successful practice, but also how to incorporate the financial side of business into your practice! Learn from the experts on MONEY, INVESTING, MARKETING, REPORT OF FINDINGS, BUILDING A SUCCESSFUL PRACTICE and a lot more!

120 Day Countdown To Your Ideal Practice

The time to be ready for the future is now. Dr. Gay will instill enthusiasm in the young chiropractor as a solid foundation to the decisions and challenges ahead. Create the future with a solid positive attitude and obtain invaluable insight to aid in decision-making goals and plans prior to graduation. Learn about the business side of chiropractic care and get a head start by creating a “blueprint” such as specific goals and necessary timelines including the many components required for establishing your ideal practice, from locating a space to preparing your promotional materials.

Visit UltimatePractice.com To Sign Up For Your Next Ultimate Seminar!

866.797.8366


Memberships

OUR MONTHLY MEMBERSHIPS INCLUDE,

but are not limited to:

PREMIER

(Great Starting Point)

$99

ON DEMAND, as needed consulting by phone, email, legal documents and forms On-site visitation clinic assessment Goal assessments and statistical analysis Doctor and staff brainstorming discussions Professional Training - Manuals, Conference Calls and Accountability Scheduled One-on-One 30 min. phone/email coaching sessions Marketing and advertising ideas

All seminars included Email coaching session 1 Recorded Webinar per month

1 / Month

1 Recorded Conference Call per month Actionable PDF Download Limited Monthly Downloads - Practice Management, Philosophy, Finance, Staff Management Unlimited Monthly Downloads - Practice Management, Philosophy, Finance, Staff Management

 1 / Month

Online content including unlimited access to newsletters, forums, all download content BONUS - Tip of the Week


ULTIMATE MEMBERSHIP AGREEMENT Between Dr. ______________________________(Your Name) hereinafter “Member;” currently practicing at (Clinic Name) __________________________ (Address), ____________________________________ (City), __________________(State) _________(Zip), _____________ Phone #(____) ________________ (Your Clinic Phone) and Ultimate Practice, LLC, hereinafter “Consultant.” Consultant has developed specific practice building procedures, concepts and materials and offers them in a program and whereas Member desires to enroll in the consulting services and program of Consultant, the parties agree as follows: Consultant will make the following services available to Member during the term of this Membership Agreement:

Executive Package $277/month (Month to Month Agreement) • Online recorded webinar with chiropractic and business experts • Online recorded conference call with guest speaker • Downloadable Action-Step PDF • 3 Email Consultations per month • Monthly downloads from the online Practice in a Box • 50% off every seminar of the year • Subscription to tip of the week (Free Bonus)

Gold Package $600/month (18 Month Agreement) • Comprehensive Practice Analysis • Bi-monthly Coaching Calls • Goals assessment and statistical analysis • Downloadable Action-Step PDF • Unlimited Email Consultations • Unlimited access to Online Member’s Site • Complete Practice in a Box • FREE Seminars, webinars, and conference calls for 18 months! • Subscription to Tip of the Week (Free Bonus)

Platinum Package $700/month (18 Month Agreement) • Comprehensive Practice Analysis with On-site Visitation Assessment • Bi-monthly Coaching Calls • Goals assessment and statistical analysis • Online recorded conference call with guest speaker • Downloadable Action-Step PDF • Unlimited Email Consultations • Unlimited access to Online Member’s Site • Complete Practice in a Box • FREE Seminars, webinars, and conference calls for 18 months! • Subscription to Tip of the Week (Free Bonus)

Pay the whole year up front and SAVE 15%. Please read terms and conditions on the other side of this document before signing.


Getting Started

Some Free Ways to Get Started Growing Your Practice Practice Solutions Volume 1 Download FREE at UltimatePractice.com

Free 30-Minute Consultation!

Have your questions answered by an expert!

Call 866.797.8366 Free Practice Analysis!

Receive a Practice and Business Evaluation when you fax your completed Practice Analysis to:

760.736.9335 1-Month Free $600 Value

Gold Coaching Membership when you order a

Practice in a Box!

(Limited Time Only) * Some Restrictions Apply

UltimatePractice.com


GOLD $600

PLATINUM $700

DIAMOND LOYALTY PROGRAM $450

3 / Month

EXECUTIVE $277

3 / Month


Practice Analysis + Free 30-Minute Consultation Please fax completed form to:

760-736-9335

CONTACT INFORMATION: Name: ______________________________________________________ DOB:_____________________ Date: ___________________ Clinic Name: ____________________________________________________________________________________________________ Address: _____________________________________________ City:_______________________ State: ___________ Zip: __________ Office Telephone: __________________________ Office Fax: ______________________________ Cell Phone: ____________________ Email Address: _______________________________________________ Website: ___________________________________________ Hours you can be reached at your office: Monday _________ Tuesday _________ Wednesday _________ Thursday__________ Friday __________ Saturday _______________ PERSONAL BACKGROUND: What are your top three chiropractic goals? One-Year 1. _________________________________________________ 2. _________________________________________________ 3. _________________________________________________

Five-Year 1. ___________________________________________________ 2. ___________________________________________________ 3. ___________________________________________________

What are your top three personal goals? One-Year 1. _________________________________________________ 2. _________________________________________________ 3. _________________________________________________

Five-Year 1. ___________________________________________________ 2. ___________________________________________________ 3. ___________________________________________________

CHIROPRACTIC BACKGROUND: Why did you enter the chiropractic profession? ________________________________________________________________________ _______________________________________________________________________________________________________________ Where did you get your chiropractic education?________________________________________________________________________ How many years have you been in practice? [ ] 1 – 5 [ ] 6 – 10 [ ] 11 – 16 [ ] 17 – 20 [ ] Over 20 How do you consider your energy level: [ ] Low [ ] Good [ ] High Are you content with your present level of living and income? [ ] Yes [ ] No I remember important things in my life by: [ ] What I see [ ] What I hear [ ] What I feel When I make decisions I generally: [ ] Gather facts and weigh the evidence [ ] Make the right choice instantly [ ] Consult my friends and family [ ] Depends upon how I “feel” about it How much more do you want to take home per year? $_____________________ How many additional patients a day could you handle with your present office staff? [ ] 0 [ ] 5 [ ] 5 – 10 [ ] 10 [ ] 20 [ ] Over 20 FACILITY & LOCATION: Are you in full-time practice? [ ] Yes [ ] No If not, please explain: __________________________________________________________________________________________ Number of square feet in your office? [ ] 0 – 1000 [ ] 1000 – 1500 [ ] 1500 – 2000 [ ] 2000 – 3000 [ ] Over 3000 How many adjusting rooms do you utilize? ________________________________________________________________________ What is the population of residents within a five mile radius of your facility? [ ] 1 – 25,000 [ ] 25,001 – 50,000 [ ] 50,001 – 75,000 [ ] 75,001 – 100,000 [ ] 100,000 + What is the mean annual income for residents within a five mile radius of your facility? [ ] Less Than $25,000 [ ] $25,000 - $45,000 [ ] $45,001 - $65,000 [ ] $65,001 - $85,000 [ ] $85,000 + PRACTICE PROCEDURES: What is the approximate percentage of follow-through on your recommendations? [ ] 50% [ ] 60% [ ] 70% [ ] 80% [ ] 90% [ ] 100% Do you take your own x-rays? [ ] Yes [ ] No If no, who takes the x-rays? [ ] CA [ ] Associate After You Submit this Questionnaire You Do you adjust patients on the first visit? [ ] Yes [ ] No Will Receive a Free 30-Minute Do you use cash basis or prepaid series? [ ] Yes [ ] No

Consultation to Help You Strengthen the Misalignments in Your Practice!


Practice Analysis + Free 30-Minute Consultation MARKETING & ADVERTISING: What is the approximate number of archived patient files you have on hand? [ ] 1 – 500 [ ] 500 – 1000 [ ] 1000 – 2000 [ ] 2000 – 3000 [ ] Over 3000 Do you have a recall system? [ ] Yes [ ] No If your practice is properly marketed, how much can your practice grow in two years? [ ] $0-150,000 [ ] $150,000 - $250,000 [ ] $250,000 - $500,000 [ ] Over $500,000 [ ] Over $1,000,000 Describe your practice marketing efforts: [ ] Constant and coordinated [ ] Constant and uncoordinated [ ] Sporadic/Infrequent [ ] No marketing activities [ ] Series of “one-shot” deals PRACTICE ANALYSIS: Do you practice by appointment? [ ] Yes [ ] No How many patient visits per week do you perform? [ ] 0 – 50 [ ] 51 – 75 [ ] 76 – 100 [ ] 101 – 125 [ ] 126 – 150 [ ] 151 – 175 [ ] 176 – 200 [ ] 200 + How many hours per week do you spend on direct patient care? ______________________________________________________ Do you charge for all your services? [ ] Yes [ ] No If no, which services don’t you charge for? ________________________________________________________________________ Do you participate in ancillary revenue streams in your practice (i.e. imaging, physical therapy, massage, etc.)? [ ] Yes [ ] No Do you participate in joint ventures with other doctors and local business people? [ ] Yes [ ] No How many new patients do you receive in a month? [ ] 0 – 10 [ ] 11 – 20 [ ] 21 – 30 [ ] 31 – 40 [ ] 41 – 50 [ ] 50 + How many vacations (not seminars) do you take every year? [ ] 0 []1 []2 []3 []4+ How interested are you in taking more time off from practice? [ ] Very Interested [ ] Somewhat Interested [ ] Not Interested How soon do you want to retire? ________________________________________________________________________________ How well does your current practice connect you with your personal ideals? [ ] Very Well [ ] Somewhat [ ] Not At All COLLECTIONS: What is your average collection amount? [ ] $0 - $25 [ ] $25 - $50 [ ] $50 - $75 [ ] $75 - $100 [ ] Over $100 What percentage of your current active patient list is insured? [ ] 0 – 10% [ ] 11 – 20% [ ] 21 – 40% [ ] 41 – 60% [ ] Over 60% What percentage of your current active patient list pay you in cash? [ ] 0 – 10% [ ] 11 – 20% [ ] 21 – 40% [ ] 41 – 60% [ ] Over 60% What income production do you have when you are out of the office? ________________________________________ How much in added collections do you want for your practice over the next 12 months? [ ] $0 - $10,000 [ ] $10,000 - $25,000 [ ] $25,000 - $50,000 [ ] Over $50,000 [ ] Over $100,000 [ ] Over $200,000 How secure do you feel financially in your current practice? [ ] Very Secure [ ] Somewhat Secure [ ] Not Secure PRACTICE SOLUTIONS Which of the following do you need detailed training in: [ ] Consultation [ ] Examination [ ] Patient control [ ] Referrals [ ] Increased Income [ ] Personal injury practice [ ] Staff acquisition [ ] Staff training [ ] Sign evaluation [ ] Bldg. Plan/recommendations [ ] Money management [ ] Keeping “the dogs off”

[ ] Report of Findings [ ] Examination procedures [ ] Insurance procedure [ ] Advertising [ ] Industrial Practice [ ] Associate doctor practice [ ] Staff management [ ] Location evaluation [ ] Floor plans [ ] Overhead control [ ] Selling your practice [ ] Other:____________________

IN SUMMARY: What do you see as your biggest need right now? [ ] More Income [ ] More Enjoyment [ ] Less Stress [ ] More Time Off [ ] More Patients [ ] Less Administrative Hassle [ ] Other _______________________________________________ What assistance would you like from Ultimate Practice? __________________________________________________________ ____________________________________________________________________________________________________________ Do you have a Mission Statement for your clinic? [ ] Yes [ ] No If yes, please define: __________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ My practice seems to be doing very well. [ ] Yes [ ] No My practice needs help or change in various areas. [ ] Yes [ ] No My practice definitely needs a practice manager and consultant. [ ] Yes [ ] No After You Submit this Questionnaire You My practice definitely needs a consultant, but I don’t want to admit it. [ ] Yes [ ] No Will Receive a Free 30-Minute Consultation to Help You Strengthen the Misalignments in Your Practice!



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