Dental Fee Analysis - Fee Analysis

Fee Analysis Enrollment Agreement - How do I get started?

We Know You're Busy! Simply fill out the enrollment agreement and practice information information, contact information for the person in your office you designate as your company contact, and your credit card/payment information. We will contact you ASAP to receive your current fee schedule and Twelve Consecutive Months of the number of procedures done per ADA code (computer generated).

REQUIRED FIELD - "*"

*Yes, I would like for William R. Morgan, D.D.S., Inc. to do an Initial Fee Rebalancing for my practice. Please charge my credit card $394.00 for four consecutive monthly payments. Total cost is $1,576.00. I understand that if my fees cannot be rebalanced to increase my profit at least $10,000.00 per year, a full rebalancing will not be done and my credit card will not be charged.

Office Contact Information
*First Name:**	*Last Name:**
*Practice Name:**
*Doctor:**
*Mailing Address:**
*City:**
*State:**
*Zip code:**
Country:
*Phone:**	( ) -
FAX:	( ) -
*Email:**

Do You Have A Management Consultant? If so, please fill out the following information:

Management Consultant:

Name:

Email Address:

Telephone Number:
( ) -

Would you like a copy of your report sent to your management consultant?

	Yes
	No

How did you hear about us?*

Practice Location Zip code*:

Date of last fee raise*:

Month:

Year:

How often do you raise fees?*:

Do you think your fees are*:

Does your staff think your fees are*:

Do you participate in Delta Dental or other PPO*:

Yes. Approximately what percentage of your patients
have Delta Dental or a PPO Insurance?

Where do your fees usually stand versus UCR?

Average new patients per month*:

Approximate overhead percentage*:

*I agree that the information provided by William R. Morgan, D.D.S., Inc. will be used solely for my practice and personal use. I understand that sharing this information with another dentist, group of dentists or dental provider could be construed as price-fixing and violate antitrust or copyright laws.

Yes, I would like for William R. Morgan, D.D.S., Inc. to continue to make sure my practice is not leaving money on the table. This includes a new fee schedule each year based on the most up to date, zip code specific data, an evaluation of the procedure counts per procedure code with recommendations to improve your profitability, an annual update of any insurance coding changes and answers to you and your staff concerning fees and insurance coding. The cost is $1,350.00; $112.50 per month conveniently placed on your credit card. This allows your practice to have a profitable, consistent fee strategy and procedure code evaluation annually.

Security Code:

I personally guarantee a minimum increase of $10,000 per year in your practice profitability by utilizing the Initial Rebalancing and Yearly Fee Strategy Service or your money will be refunded.

Dr. William R. Morgan

William R. Morgan DDS
1107 East Matthews Suite. 101
Jonesboro, AR 72401
email: fdmorgan@swbell.net