Cutting down Costs vs. Increasing Production

Pretty much every owner wishes to increase their net income. Factually, there are only two ways to accomplish that: (1) cut back on expenses and (2) increase production. Now, while it is wise to do both, you might be surprised as to which one generates the most profit. Let’s take a look.

We’ll examine a single-doctor practice that is grossing $600,000 per year and we’ll set the following two parameters:

  1. If the practice runs efficiently, it could generate $1,000,000 per year.
  2. In this particular profession, the staff salary is supposed to be 22% of the gross, but is currently running at 26% – 4 percentage points above the conventional norm.

If the executive pared their staff salary expenses down to the norm (i.e., reducing it from 26% to 22%), that would increase profit by $24,000. Not bad.

But what would the profit be if the executive were to focus on expanding the practice up to the $1,000,000 mark? At that higher level, there would be an additional $400,000. Obviously, not all of that is profit. But how much of it is?

To sort this out, you would need to look at the difference between fixed costs and variable costs. Fixed costs are those that remain constant, regardless of the production level. Rent, certain insurances, license fees, etc., are expenses that are the same amount whether the practice produces $1 or $1,000,000 per year.

Variable costs, on the other hand, are costs that vary with production. Depending on the type of practice, the two greatest variable costs are 1) payroll and 2) either inventory or lab/clinical supplies. Combined, they represent anywhere from 40% to 50% of income, depending on the profession. There are a few other variable costs that will increase the percentage slightly; but for the sake of ease of explanation, we’ll focus on just those two costs.

Let’s factor in the fixed and variable costs to this $400,000 increase and see what our profit is. First, the fixed costs have already been paid from the original $600,000 income; you obviously don’t have to pay more rent because you earned an additional $400,000. The same is true of the costs of the annual license fees and probably accounting, legal and other such fixed expenses. Those bills have already been paid.

The only additional expense you incur when you produce an extra $400,000 are the variable costs. We’ve already calculated that the combined fixed and variable costs will be as much as 50% of production; so, producing an additional $400,000 will cost $200,000. The remaining $200,000 is profit.

While the choice may be abundantly clear, let’s take a look at the ramifications of the direction you decide to take and the effect that it could have on both you and your practice. Read the final half of this article by filling out this form.

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How to Guarantee a Satisfactory Retirement Fund

It is never too early in your career to start funding your retirement. You may only be one day out of school, but you should be thinking about and planning out a retirement fund.

We have found from our surveys that an ongoing decline of interest in practice ownership is making it increasingly difficult for practice owners to sell their practices, and this is causing many doctors to work in their practice years after they wanted to leave.

Unfortunately, less and less new graduates want to own a practice. More of them are looking to become associates in a practice, work 35–40 hours a week and start out with full benefits.

As part of my research, I recently spoke to a doctor in Ohio that was at retirement age. He had been in practice for over 38 years and was ready to retire. I asked him if he had adequately funded his retirement, and he told me that he had always thought that when the time came, he would sell his practice and have plenty to retire on. He found out that he was mistaken.

When I talked with him, his practice had been up for sale for over 3 years, and he couldn’t find a buyer. And of course, he was still working as he had not adequately funded his retirement outside of a practice sale. He was counting on the sale of the practice to handle his retirement. He found out, way too late, that such a plan is not always workable.

I’m hearing this story more and more from doctors all over the country.

Here are a few things that you can do to protect yourself from this situation:

  1. Place a portion of your monthly overhead into your retirement fund. Budget this in from the start. Retirement is something that needs to be figured into the overhead so that it is taken care of every month. Treat it as you would an equipment lease, a mortgage or employee salaries. Make it an ongoing expense.
  2. Find a financial planner that can properly advise you on what to do with the money that you set aside each month. Get a professional involved to help you find the best vehicle for your retirement plan.
  3. Own your practice real estate. This is a big one. Real estate is something that you can always fall back on. Even if you can’t find a buyer for your practice, you can sell real estate. If you own the building, and you find someone to buy the practice, you can lease the building to them and make a residual monthly income off the lease and have that extra income.

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Resolving Negativity in the Office

Since dealing with staff bickering and personality conflicts can be a major source of stress in an office, knowing how to deal with it can be extremely useful. When you let employee situations linger too long, bad things happen, and you can end up losing not only the problem employee but other good employees as well. So, when you encounter two or more employees feuding, our recommendation for you is to find out as quickly as possible who seems to be instigating the problem, as well as determine which of the two employees is the most productive, and to quickly nip it in the bud.

Normally, when a feud is going on, other staff members have either been involved or have observed it in one form or another. It usually bothers them as well, even if they are not directly involved. What we recommended to practice owners is to interview these peripheral staff and get a more neutral opinion of what’s going on and who is really causing the problem. Also, interview the staff involved and get their respective sides of the story. From this you should be able to find out who the real problem employee is.

ACT FAST! The longer you let something like this linger, the greater the odds that you will lose not only the problem employee, but the good employee and possibly other staff members who are sick of being involved in that type of work environment. If you act swiftly on such matters, you will keep your employees happy.

There’s another very important point: the longer this kind of thing is allowed to continue in your office, the more likely it is that other staff members will start to feel that their workplace is not safe. They will also feel that the owner is not in control of the office and that they may want to find a better environment to work in. You could end up losing a really good employee because you didn’t confront the problem and act swiftly and appropriately.

Having the right office policy and job descriptions in place to govern acceptable and unacceptable behavior in the workplace will give you an important foundation to stand on when handling this kind of situation. Lack of such policy can make the workplace less than harmonious. And don’t forget to document, document, document the non-optimum issues in writing and what was done to handle the people involved. Without documentation, you can open yourself up to potential legal issues.

The “staff infection” is a term that I came up with long ago to discuss the effects that a negative employee can have on a team and how fast it can spread. Similar to how the “Staphylococcus Infection” is dangerous to the body.

The “staff infection” starts in various ways, such as with a staff member that often rolls his or her eyes at staff meetings. This staff member engages in rumormongering and can be counted on to “stir the pot” in the office. This can be the idle staff member or the person who always seems to be busy but gets nothing done. You get the idea. This is the employee that you are “just not sure about.”

What would you think of a doctor that did not practice good sepsis control and permitted Staphylococcus germs to fester in or on his or her equipment? It simply does not make sense, does it? Nobody would do that. Preventing any sort of infection in a patient is more than second nature to any doctor. What would your opinion be of a doctor that was aware that his or her patient had an obvious staph infection but did nothing about it? Enough said.

How do you handle the “Staff Infection”? Read the final half of this article by filling out this form.

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Did You Hire the Wrong Person?

A recent survey conducted with practice owners across the US revealed that the number-one management problem they have is personnel issues. Among the problems mentioned by hundreds of owners surveyed were:

  • Procuring qualified personnel,
  • Getting employees to perform competently once hired,
  • An inability to hold staff members accountable for their work,
  • Turnover and handling disputes among employees.

Correctly isolating and debugging non-optimum practice situations is a skill that every doctor finds he needs. Oftentimes, a manager who is seeking solutions overlooks some administrative fundamentals which, left undetected, cause a problem to appear larger or more complex than it really is. Moreover, failing to discover the real source of a problem leads to poor decision-making. In the case of managing employees, this type of failure is not only frustrating, it’s expensive.

The real work begins after the hiring process ends, for each employee must be well trained for his/her position in the practice. Lacking thorough training, an employee will not perform to the expected standard. That will inevitably lead to either the employee quitting or the doctor firing him/her.

There is an exact technology for finding and hiring good staff members. Assuming the hiring techniques are sound, the most devastating managerial mistakes are made during the training period. During that time, an unskilled manager might make assumptions that lead to incorrect reasons for poor performance, and those conclusions, in turn, lead to bad decisions regarding personnel. All too often, a suitable person who is both willing and trainable fails to receive the information needed to do the job. As a result, turnover occurs and doctors and office managers spend their time dealing with personnel problems rather than treating or servicing patients.

Written job descriptions are a must for each position in a practice. More importantly, those descriptions need to include fundamental data that are often omitted because the manager assumes that the employee already knows what is needed from him. Common sense, or common knowledge, to one person may not be so to another. Verbal instructions are much less effective than thoroughly written job manuals.

Every job description in an office should include the seven following sections:

  1. The responsibilities that the person holding the job position has to the patients,
  2. A general description of the position, which includes its purpose,
  3. A statistic that quantifies, and thus objectively measures, the production of the position,
  4. A list of specific duties that one in the position is expected to perform,

What are the final three sections that a job description should contain and the four things to examine when employee problems arise? Read the final half of this article by filling out this form.

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A Functioning Office Manager

Your Key to Success

The primary function of the office manager is to accomplish the goals and purposes of the practice as determined by the owner of the practice. The OM should assist the owner in developing policies that forward the purpose of the business as a whole. It is the OM’s job to see to it that all members of the group are fully contributing to the expansion of the practice, and that a high level of communication exists between the group and the owner.

The OM should run the day to day activities of the office and keep the daily distractions off of the owner/doctor’s plate. This would be accomplished by ensuring that the OM, first of all, was trained in the handling of staff and felt comfortable with the hiring, training and correction of all staff members.

The OM should be a person who understands the importance of communication and the power that open communication can generate within any group. The OM should energetically lead the group toward accomplishment of the established goals. The OM should be someone with good communication abilities and someone who can really care for the staff.

The OM would ensure that all internal communication systems are strongly in place and operational, and that the staff is taking responsibility for keeping all unnecessary “traffic” from and within their own posts to a minimum.

To affect the above, the OM should have a strong working understanding of the management tools such as statistical management, the establishment of a communication system that really works for the office, written communications, job descriptions for each position, written policies for the practice, and personnel management.

The OM is in charge of seeing to it that all areas in the practice are running smoothly and producing the desired products of each respective area. This would require her/him to have an understanding of organizational structure and function. They would ensure that all functions in the organization were being firmly held by someone and that they were trained in the skilled handling of their assigned posts.

The OM should have a very strong working knowledge of statistics and their use in strengthening the practice. The OM would be in charge of posting statistics and going over those statistics with the staff in the staff meeting to determine the appropriate steps to take in order to improve, maintain, or increase practice production statistics.

It is the OM’s responsibility to obtain compliance from all staff in regard to the owner/doctor’s wishes and any program or project steps that are being worked on.

The OM would be responsible for the hiring and firing of personnel and for conducting performance evaluations on a regular basis with all staff.

The OM is responsible for the preparing and implementation of programs that would take the group through the needed steps toward the accomplishment of company plans.

Fill out the form to read the rest of this article which includes: 5 key objectives of an OM, the results the OM must obtain for the practice and how to select an OM (highly recommended). Scroll to top

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Optimize Your Marketing

In today’s economic climate a great deal can be said for the benefits of marketing effectively. There are many mediums for marketing a practice – referrals from existing patients/clients are normally the best and most cost effective means of getting new patients/clients. External marketing, such as the Internet, business directories, new resident mailings, bus benches, and even the local newspaper, radio and TV, has worked for some. Some form of one or more of these has proven to be successful in various markets, but not all of them are effective in all markets. Given all this, it is vitally important to know how your new patients/clients are finding out about you, and based on this, you should focus your marketing dollars in the most effective areas.

This brings up the topic of this Hot Tip.

Somewhere on your new patient/client form there should be a little line that says, “How did you find out about our practice?” If you don’t have this line on your new patient/client form, you should institute it right away. Some offices have little check boxes that mention their various marketing activities, and others just offer a blank line to be filled in. However you do it, the purpose of this is for your new patients/clients to tell you which of your marketing tools have been most effective. This is vital information for your promotional and marketing activities, only as long as you do something with it. Unfortunately, many doctors don’t use this information properly.

In fact, the last poll taken in our online journal “The Practice Solutions Magazine”, showed that 54% of those responding said that they “did nothing” with the information that they got from this question on their forms. At the same time, our current poll shows 43% stating that they are increasing the amount of marketing they are doing currently. The poll data seems to support that “marketing for new patients/clients” is important to practice owners but the importance of tracking effectiveness of marketing seems to be missing.

Let’s take up effectiveness of marketing as a running theme and discover how it might be used. A simple starting point would be to actually use the data you have already gathered by doing a quick breakdown of where your new patients/clients came from for the past 6 to 12 months. Assign your front desk person the task of reviewing the files of all your new patients/clients and tabulate their responses to the question concerning what brought them to your office. Once the tabulation is done, have this staff member provide you with a summary of this information – i.e. “45% came from referrals, 20% came from new resident mailings, 10% from Yellow Pages ad, etc.” Use the results from this summary and locate the area(s) that seem to be providing you with the most new patients/clients. Do not be surprised if “referred by a friend or relative” shows up as the number one item – in fact you should be surprised if it doesn’t.

At this point, inspect your marketing budget. How much do you spend to make sure people know how to find your practice? How much are you spending on ads and how many new patients/clients came from that? What kind of materials do you have to stimulate referrals? Examine each area that you are spending your marketing dollars on and what your return is on those dollars. While taking into account the cost effectiveness of each activity, you’ll want to invest more heavily in the area(s) that are giving you the most return. For example, if “referrals” is your number one draw, and the local radio ad is not producing much, how can you shift your advertising dollars into more support activities for referrals? As an example, creating a “Refer a friend or family member” card might be one way to start.

To summarize:

  1. have a means to know where your new patients/clients are coming from;
  2. don’t ignore this data – tabulate and evaluate the information;
  3. invest your marketing budget in the most effective areas based upon the data you gather;
  4. regularly re-assess this information and adjust your marketing plans and investments accordingly.

If you do the above regularly and religiously, you’ll find a steady increase of new patients/clients coming in your door. The first priority is always to strengthen the area that is working best, before looking to add additional avenues.

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We offer any practice owner the opportunity to receive one of the below gifts in exchange for a 15 minute, anonymous phone survey (at the date and time of your choice) that will assist upcoming publications by The Practice Solution Magazine. As always, we are very grateful for your help in making our publications better.

  • Phone Consultation (1 hour) on a management topic of your choice. Subjects include: staff management, hiring, marketing, financial issues, how to set fees, increasing net profit etc.
  • Comprehensive website marketing analysis.
  • Job Description Pack – Practice Owners (Valued at $129 – for an additional 15 minutes phone survey)
  • Human Resource Testing – Two applicant testing evaluation packages. (This includes an IQ, Personality and Aptitude Test for each applicant and evaluation)









Recruiting New Employees

Who, what, when, where and how:

It is a 100% certainty that with any practice you will need new employees at some point in time, either to replace employees who leave or to help the practice grow. Where do you find the type of people you want to work with, people that you can trust and who will want to see your practice succeed?

Posting on the Internet and in the Newspaper:

The most obvious resources to use in recruiting new personnel are the internet and the newspaper. Before we discuss the ad itself, let’s take a look at some basics. The best place to place your want ad is going to be online. There are several websites that you can use to find a qualified employee, such as Careerbuilder.com, Indeed.com, Monster.com, Glassdoor.com, and Craigslist.com.

Never lower your standards when looking for a staff member. Keep your standards high and remember that you not only want a top quality person, but you deserve that person! Your practice growth depends upon people who are bright, energetic, sensitive, intelligent and outgoing. Be willing to compete for that type of person.

Also, realize that the type of person you are looking for may not be actively looking for new jobs. Some of the most qualified individuals already have jobs, but they may be looking for a change. These individuals may seem like “cold prospects,” but they actually do skim through the want-ads just to see what is out there. So, it is very important to develop an advertisement that will attract the person you are looking for.

For newspapers, Sunday is definitely the best time to run your ad. Even though newspaper sales have been declining in recent years, it isn’t out of the question to use it as a means of finding new hires. Running an ad on both Sunday and Monday would be the most successful combination because people who are looking will look through Sunday’s paper and continue “looking” at least through Monday’s paper. Do not waste your valuable ad dollars by advertising right before a major holiday, as people are less likely to read the classifieds. They are too involved with other matters, and will usually look after the holidays.

Part two of this article will go over tips on how you develop your ad and how to use hiring agencies.

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Screening Applicants

The Group Interview
Finding a new employee is a very time consuming process. To consolidate efforts and streamline the initial stage of the interview and selection process, have all of the applicants who meet the basic criteria come into the office for a group interview session. The purpose for this is that it consolidates the office manager’s efforts, giving you an opportunity to get a look at the applicants and screen out those whom you do not care to invest any more time in. The finalists from this segment will then be invited back for an in-depth individual interview.
Once you have collected all of the resumes from your advertising, go through them and screen out those that do not have the qualifications you are looking for. Take into consideration whether or not the applicant included a cover letter and whether that letter really communicates something about the applicant. Look at the experience, background and talents being conveyed in the resume and letter.
The First Interview
Phone those applicants that appear to be the very best and schedule them to come into your office to fill out an application. During this phone call you can rate their phone voice and composure and get a bit of a feel for their willingness. Make notations on the resume. Schedule all of the applicants for the same time, e.g., an evening after work or on a Saturday morning.
Make preparations ahead of time. Have packets of paperwork ready for each of your applicants. Their packets will contain an application, a questionnaire, a sheet that they will fill in with their employment goals and what their understanding of a practice is. They will also be asked to write a brief collections letter and sign an Authorization for Release of Information form.
When the applicants arrive, welcome them and deliver a brief statement (10 minutes or less) about the practice, its purpose/mission and the position. Then, direct them to the pre-printed packets handed out. Have them:
  1. Fill out their Job Application Essays.
  2. Fill out their Hiring Questionnaire. Asking them what your practice is about, its purpose, the position that they are applying for and a few negative and positive things about the position or practice.
  3. Write a brief letter to a client who has an overdue account (which gives you a good indication of how the person deals with others on sensitive matters).
  4. Sign and date the Authorization for Release of Information form.

As the applicants complete their forms, rate them on their appearance (1-5) and take them individually into a private office to conduct a brief interview (about 5 minutes for this first interview). This will give you a feel for the person.

Before your applicants leave, give them each a card for a complimentary exam at your office. (This is optional, but could garner a new patient even if not hired). Thank them all for coming in and let them know that they will be hearing from you within the next couple of days.

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Vital Steps for Collecting Money Over the Phone

In any practice, Accounts Receivable exist. Whoever collects money in your organization needs to know that this particular job has a two-fold purpose:

  1. To bring the patient/client’s account current
  2. To maintain sufficient goodwill with the patient/client to ensure his continued patronage and support.

The statistics that can be used to measure how effectively the job is being done are:

  1. Money collected (Amount)
  2. Number of accounts brought current

TELEPHONIC COLLECTIONS PROCEDURES

Your telephonic communication skills are very important. Following are some guidelines and proven techniques that will assist you in being most effective in collecting outstanding payments from your patients/clients over the telephone. 

PRIOR TO THE CALL

  1. Study the patient/client’s account record, and all related documentation to ensure you have ALL the information necessary to make an effective and accurate collection call. Spotting a past due amount on your aging report and then picking up the phone to call the patient/client, without pre-planning, is not a very good idea, as there may be vital information of which you’re not aware. Placing the call without doing your “homework” could result not only in NOT getting paid, but in creating an upset with the client/patient or poor PR for the practice. So, study the file prior to making the call.
  2. Know the correct name of the person with whom you are planning to talk. Make sure that you have his/her complete name, spelled correctly. It is vital to speak with the person responsible for the account, so ensure that you have that data.
  3. Be in the right frame of mind when you place the call. Think positively. Believe that you are going to resolve the account. Do not call in anger, frustration or anxiety. You will get nowhere with your patient/client if you do so. Be both cheerful and professional.

MAKING THE CALL

  1. Introduce yourself and state the purpose of your call.
    Example: “Hello, Mr. Smith? This is Mary Jones from Dr. Nelson’s office. How are you this evening?  I’m calling you about your account. Do you have a few minutes to talk with me about this?”
  2. Be very deliberate in your statement about the account. Do not rush through this or be difficult to understand:“Our records indicate that you have an outstanding balance of $350, and I am inquiring as to when we might expect that payment.”Now give him an opportunity to respond.
  3. Do not make him feel embarrassed or as though he has done something wrong. Do not verbally attack him. Notice that in the above example it states, “Our records indicate…” Avoid statements such as: “I’m calling about the $350 that you haven’t paid us for four months!” This would definitely get you off on the wrong foot with him, and it would be quite difficult to resolve the ensuing conflict.
  4. The tone of your voice is very important. Do not be hostile or angry. Do not think of the client/patient as a “deadbeat” or a big problem. Think of yourself as a problem solver and come across that way. He will see that you are trying to help and will be more willing to help in return.
  5. After you have identified yourself and stated the purpose of your call, STOP!! Don’t say anything more at that point. It may seem like forever, but if you wait for the person to say something, it will go much more smoothly, as he is now having to originate a response to you regarding your inquiry.
  6. Listen to what he has to say. Don’t just hear it, but really listen and understand. It could be that he has already mailed the check, or maybe he was planning to mail it that day. If you come on with a harsh demand for payment, you could stop an already intended payment. So, give him a chance to talk.
  7. If he resists, registers an objection or is just generally uncooperative, let him say everything he has to say. Let him know that you understand, and then handle the objection, confusion or whatever it is by giving him an honest and realistic answer. If you do that, you will get a full picture of what his objections are, and you will have left him with little or no argument to fall back on once you have handled the objections he put forth.
  8. Don’t be brash or punitive. Understand that this is a tough position for him to be in. Don’t harass or attack him. Don’t make a threat (such as a lawsuit), except as a last resort and ONLY if you fully intend to carry it out.
  9. Go over with him the fact that it is to his advantage and benefit to make payment. Let him know that the advantages include: not getting turned over to a collection agency, feeling better because an agreement has been worked out, no harm being done to his credit rating, etc.
  10. Bear in mind that everything he has to say might sound very reasonable. But also remember that those “reasonable” explanations are the very “reasons” why he’s in a bind in the first place. The explanations won’t handle anything.

Fill out the form to learn the remaining 5 indispensable collection call techniques AND to find out the 5 vital steps to take AFTER the call (highly recommended). Scroll to top

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Getting Clients and Patients to Be Accountable for Cancellations

You need to put a system and policy in place to discourage your clients or patients from unnecessarily canceling appointments. First, you should have a company policy that is given to your clients/patients as part of their “Welcome to the Practice” handout, letting them know what is considered a no-show—usually less than 24 hours’ notice—and what happens when a no-show occurs. It is important to make sure that your clients/patients are aware of this policy before enforcing it, or you might create an upset.

Clients or patients who wish to cancel an appointment on short notice or who fail to come to a confirmed appointment need to be gently challenged on missing that appointment. An attempt should be made to get them to keep the appointment if at all possible, and if that doesn’t work, they should be notified of the $25.00 fee to be collected at or prior to the next visit. If the client or patient still wishes to cancel, he or she is to be rescheduled. The fee should only apply if the client/patient has already been given his/her “first-offense warning.” The idea behind the fee is NOT to anger the person or make the person wrong but to inform him or her that you are serious about the importance of appointments being kept and completing a course of treatment on time.

The script would be something like this: “You can’t keep your appointment? Oh dear! The doctor has this time set aside especially for you. Is there anything you can do to make it?” If that doesn’t work, move into the missed-appointment-fee handling.

  1. For the first offense, the office policy is to waive the fee. The client/patient should be notified of this, and it must be documented in the chart by the receptionist. The ideal way to approach the individual is by saying, “Mr. Jones, it is our office policy to charge $25.00 for late cancellations or missed appointments; but since this is your first offense, we will waive the fee. Now, let’s get you rescheduled. . . .” This message should be practiced so as to be said all at once and in one breath. The entire message should be delivered before the person can interrupt. This part is very important. You should have the client/patient chart in front of you so that you can be accurate in telling the person of his first offense and the waiving of the fee. If you do not have the client/patient chart in front of you, treat the person as if this were the first offense and note it in the chart.
  2. For the second offense, a client or patient will be called by the OM because a second failure may mean that the person is upset or unclear about something in the treatment. Please give the chart to the OM so the client/patient can be called that day. This must be documented in the chart.
  3. For the third offense, the client/patient will be sent a letter that will require a $25.00 payment for missing the appointment, plus a $25.00 payment to be held as credit for the next appointment, for a total of $50.00. This must be documented in the chart.

If you have any questions regarding this procedure or its implementation, fill out the form to schedule a free call and we would be happy to assist you.

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If you have any questions regarding this procedure or its implementation, fill out the form to schedule a free call and we would be happy to assist you. (highly recommended).