Episode 75

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Published on:

19th Aug 2026

The Patients You Already Have

In this week's episode, our discussion centers on the implications of patient retention within dental practices, wherein we assert that the most financially burdensome patients are those who are new, while the most cost-effective and lucrative are those who are already familiar with the practice. We explore the troubling phenomenon of patient attrition, and look at how practices often inadvertently allow existing patients to depart without securing their return, thereby incurring unnecessary marketing expenses to attract new clientele.

Our analysis reveals that many practices are unaware of the significant patient loss occurring quietly, often masked by seemingly stable production numbers. We emphasize the necessity of measuring and addressing this attrition through effective systems and practices, particularly focusing on the last moments of a patient's visit. We provide actionable strategies to enhance reappointment rates, which are essential for fostering a sustainable and profitable practice.

Things to Takeaway:

  • The most expensive patient in your practice is a brand new one, highlighting the importance of retaining existing patients for profitability.
  • Practices often fail to recognize the significant loss of patients leaving unnoticed through the back door rather than gaining new ones.
  • The hygiene reappointment percentage serves as a critical metric to gauge patient retention and overall practice health.
  • The last 90 seconds of a patient visit are crucial for ensuring a follow-up appointment is scheduled, directly impacting retention rates.
  • A proactive approach to patient reactivation can yield substantial financial benefits, as many former patients simply need a reminder to return.
  • Effective communication during the scheduling process is paramount; using assertive language can significantly increase the likelihood of follow-through on appointments.

Want to learn more about how KLAS Solutions can coach your team? Contact us at: info@klassolutions.com or 844-552-7100 or visit our website to learn more: klasdentalcoaching.com

Transcript
Speaker A:

The most expensive patient you'll ever get is a brand new one.

Speaker A:

Marketing ads, the website, the review, the whole cost of getting a total stranger to trust you enough to open their mouth in your chair.

Speaker A:

The cheapest and most profitable patient you will ever treat is one who already knows you, already trusts you, and has already sat in that chair.

Speaker A:

And most practices are leaking those patients out the back door faster than they're bringing new ones in the front.

Speaker A:

Here's what makes this the quietest problem in dentistry.

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It never shows up on a bad day.

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Nobody walks in Monday morning and announces that 400 patients left last year.

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It shows up as a slow year.

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It shows up as production that feels soft for reasons that no one can name, while the owner writes bigger and bigger checks to marketing to replace patients who are already paid for.

Speaker A:

Today, I am going to show you exactly where that leak is.

Speaker A:

The one number that measures it, the 90 seconds that fix it, and the list sitting in your software right now that is worth more than your next marketing campaign.

Speaker A:

This is the Dental Business podcast brought to you by Class Solutions.

Speaker A:

We are one team, five divisions aligned around your practice and I'm Phil Cole.

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For 27 years in this industry and I have valued, coached, bought, sold and rebuilt practices in every kind of market you can name.

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This is a solo episode, which means it is just you and me for the next half hour.

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And I'm going to be direct with you.

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I'm going to walk you through the single highest return project available to almost every practice I look at.

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It costs you nothing in advertising.

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It requires no new equipment, no new operatory, and no new associate.

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It is a system and once it is running, it pays you every month for the rest of the time that you own your practice.

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So, hey, grab a pen.

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Some of this you are going to want to write down and hand to your team tomorrow morning.

Speaker A:

This episode is going to be brought to you by our class.

Speaker A:

Coaching the patients you already have are your most profitable growth.

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Let a class coach help you keep them.

Speaker A:

Go to classdentalcoaching.com and learn more about us.

Speaker A:

Let me start with why you cannot feel this happening.

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Attrition happens one patient at a time.

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A patient finishes a cleaning.

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They're pleasant, the visit went well, everybody liked them.

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They get to the front and they say, you know what, my schedule is really crazy right now, so let me take a look at my calendar and I'll give you a call.

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And then they walk out the door unscheduled.

Speaker A:

That is one patient, so it doesn't really Hurt, Right.

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Nobody in the building ever remembers it happened by lunch.

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There is no alarm.

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There's no red light on the wall, no report that prints at the end of the day telling you that you flipped a coin on whatever you saw that would ever see that person again.

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Do that four or five times a day, every day for a year.

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Well, let me put some real numbers on it, because the numbers are what makes owners sit up.

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Say you run two hygienists, with each seeing 10 patients a day, four days a week.

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That is 80 hygiene visits a week, right?

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Around 4,000 hygiene visits a year.

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Reasonable size practice, Nothing extreme.

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Say 70% of those patients leave with their next Visit already booked.

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70% Sounds really good, right?

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It sounds like a B minus.

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Maybe the most owners would guess that they're somewhere around there.

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Well, 70% means 21,200 patients walked out of your building last year unscheduled.

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Twelve hundred.

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And in practice after practice, roughly half of the patients you leave unscheduled never come back at all.

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So call it now.

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600 Patients gone.

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What is a patient worth?

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Take an average active patient producing somewhere around $800 a year between hygiene radiographs, the restorative that gets found along the way.

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600 Patients times $800 is $480,000 a year in production.

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That is no longer walking through your door, and that is one year of attrition.

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That's not cumulative damage.

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Here's the part that should make you, I would hope, angry.

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You already paid for every one of those people.

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Depending on your market, a new patient costs somewhere between 250 and $400 to acquire.

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And in a competitive metro, it runs well past that.

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So the practice writes a marketing check every month to bring in 25 new patients at $300 a head.

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Celebrates the new patient count in the morning huddle and never notices that 30 patients quietly left through the back door the same month.

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So when you look at that, that practice isn't growing.

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It is treading water at full sprint, and it is paying full retail for the privilege.

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There's a number that tells you the truth about this and is not new patient count.

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It's active patient count.

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That is the number of unique patients who have been seen in your practice in the last 18 months.

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Some will say 24.

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Not the number of charts in your software.

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Charts are just history.

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Active patients are your business.

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You know, when I sit down with an owner and we look at active patient count over three years and the line is flat, while they've been spending on marketing the whole time, we have found the problem.

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The front door is working.

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The back door, though, is standing wide open.

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So how do you measure the leak itself?

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Well, one number.

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Hygiene reappointment percentage.

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The definition is simple.

Speaker A:

Of all the hygiene visits you completed in a given month, what percentage of those patients left the building with their next hygiene visit already on the schedule?

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Completed hygiene visits with a future appointment booked, divided by total completed hygiene visits.

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Two rules on how you count it.

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First, it has to be booked before they leave, not booked three weeks later, after four voicemails and 16 texts.

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If you count the ones you chase down afterwards, you're measuring how hard your front desk works, not whether your system works.

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Second, the appointment on the books is what counts.

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A note that says patient will call is not an appointment.

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A patient on a recall list is not an appointment.

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A promise is not an appointment.

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Here is the standard.

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Above 95%, not 80, not 85.

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Above 95.

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And the best practices I work with live at the 98 and treat anything lower as a problem to solve that week.

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When Ryan Hill, our director of coaching, gets called into a practice that is struggling with production, this is one of the first numbers we pull and it comes back at 60, 70%.

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More often than you would believe.

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That gap between where they are at 95, well, it's the leak.

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It's quantified, it's a single number.

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Now, most owners have never seen this number for their own practice, so they let me tell you how they get it.

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Every major practice management system will give you this, though almost none of them put it on the front page.

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And Dentrix, you're looking at the continuing care module and the hygiene production reports.

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And Eaglesoft, it's the recall and scheduling reports.

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In OpenDental, you can pull it out of the recall list and the appointment views.

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Cloud systems like Curve and Denicon report it more directly.

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If your team tells you the software can't produce it, well, that is not a software problem.

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That is definitely a training problem.

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And it takes about 20 minutes to solve with someone who knows the system.

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And if you want the fastest possible version, do this tomorrow.

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Pull yesterday's hygiene schedule, count how many patients were seen, then look at each one and count how many have a future appointment on the books.

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Divide.

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That is your number for the day.

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Do it for a week and you will know precisely how bad the leak is.

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And you will not need a consultant or a report to tell you that.

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Track it monthly.

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Put it in front of your team.

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A number that nobody looks at will never Improve.

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So here's the good news, and it's genuinely good news.

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This whole problem lives inside the last 90 seconds of the appointment.

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That's it.

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90 Seconds between the moment the hygienist sets down the mirror and the moment the patient walks through your front door.

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Everything about whether that patient becomes a retained patient or a coin flip gets decided in that window.

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And guess what?

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You control it completely.

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So the standard is this.

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Nobody leaves hygiene without the next visit booked.

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And it should be, period.

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No exceptions, no special cases, no we'll call you later, or we'll call them later.

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You book it at the chair while you're sitting there, while it's easy, while they're still in the mindset of being a patient in your practice.

Speaker A:

The moment they cross the threshold and step outside, your odds collapse and there's stats to prove this, and your cost to recover them multiplies.

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Inside the building, the appointment is free.

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Outside the building, it costs you three phone calls, maybe 16 texts and a piece of mail, and you still lose half of them.

Speaker A:

Now, let me talk about the language, because the language is where most practices give the appointment away.

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You do not ask, when would you like to schedule your next cleaning?

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That is a question that a no is attached to.

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And you just handed the patient the no.

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Same with, do you want to go ahead and set something up?

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How about, would you like to call us when you know your schedule?

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Every one of those invites the patient to opt out of their own care and is free to say no.

Speaker A:

Here is what it sounds like.

Speaker A:

Instead, I'm going to get you on the schedule for your next visit.

Speaker A:

It looks like we're into early March.

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Does the morning or afternoon work better for you?

Speaker A:

Now, read that again and notice what happened.

Speaker A:

You did not ask for permission.

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You assumed the appointment because the appointment is the standard of care.

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And then you gave the patient a choice between two yeses, morning or afternoon.

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Both answers, get them on your schedule.

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That is not a sales technique.

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It is how you already talk about everything else.

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Clinically.

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You do not ask a patient whether they would like radiographs this year.

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You tell them it's time and you take them.

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Continuing care is exactly the same thing, and your team should carry it with the same confidence.

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Now, the objection.

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You'll get this one constantly.

Speaker A:

I have no idea what my schedule looks like six months from now.

Speaker A:

Well, here's the answer.

Speaker A:

That's completely normal and it is why we are going to put it on the books now and remind you three weeks ahead of time if it needs to Move when you get there.

Speaker A:

Well, we'll move it.

Speaker A:

No problem at all.

Speaker A:

Holding the time costs you nothing.

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And it means that you are not calling us in eight months trying to find a spot that we're not going to be able to get you in.

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You've just removed every reason to say no.

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There's no risk to the patient.

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There's no commitment.

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They cannot escape.

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And you have taken the entire burden of remembering off their shoulders and put it on your system, which is exactly where it belongs.

Speaker A:

A few more things that make this stick.

Speaker A:

Book families together.

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If mom is in the chair and her two kids are patients, you are booking three appointments, not one.

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Same day, back to back.

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So she makes one trip, she will thank you for it and you get protected.

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Three patients instead of one.

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Do the handoff out loud in front of the patient.

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The hygienist walks the patient up and says right in front of them, Sarah is all set.

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She is due back in six months.

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And we talked about that lower right molar.

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So that lets us get her scheduled for that too.

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Now, the front desk is not starting from a zero, but patient hears that their care described as a plan and nobody has to guess what was decided in the back and reserve the time before you need it.

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Your hygiene should schedule.

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Your hygiene schedule should be built out ahead with continuing care time already held.

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So when the patient is standing there, you are placing them into an appointment that exists rather than hunting through a wide open calendar hoping to find something.

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Here's my favorite part of all of this.

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Every bit of what I just described.

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It's free.

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It is not software, it is not a new hire and it's not a capital expense.

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It is a change in how three or four people in your building use many 90 seconds.

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Ryan has walked into practices.

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I've walked into practices, changed Nothing but that 90 seconds in the language inside of it and watched reappointments climb 20 points in a single quarter.

Speaker A:

Software can send a reminder.

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Software cannot change how the hygienist talks to a patient in the last 90 seconds of the visit.

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That is behavior.

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Behavior is what coaching changes.

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There is a production hiding in your reactivation list right now.

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A class practice health assessment will show you exactly how much.

Speaker A:

Start@classdental coaching.com now, if the fix is that simple, why is almost nobody at 95%?

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Because there are four specific places this breaks and every one of them is fixable once you can see it.

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Let me walk you through all four so that you can look for them and your own practices.

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This Week.

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The first one is the soft ask.

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Your team is asking instead of telling.

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They are being polite, they are trying not to pressure anybody and their language is full of exits.

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This is the most common failure and the easiest to correct.

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It takes one team meeting, a written script and about two weeks of somebody actually holding the standard.

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The second one is the broken handoff.

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The patient gets walked to the front desk or worse, points towards the front desk and nobody up there knows what was decided in the back.

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The front desk asks the patient what they need and the patient, well, they don't know and the appointment evaporates in the confusion.

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That whole failure is a 30 second verbal handoff spoken out loud in front of the patient.

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The third one is the will call list or the call list.

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This is the graveyard.

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Somebody built a habit of writing patients down on a list to call later and that list is where appointments go to die.

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Nobody works consistently.

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It grows every week and it becomes the place your team puts patients they did not want to have a firmer conversation with.

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If you have a will call list or a call list, look at it today and ask how many of those people have been contacted in just say the last 30 days.

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The answer will tell you what you need to know.

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The fourth one is unscheduled treatment and this is the leak.

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Inside the leak, the doctor diagnoses a crown.

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The patient says they need to think about it or check with their spouse.

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Nobody schedules anything, nobody sets a date to follow up.

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And that crown sits in the software as diagnosed and unscheduled and it most likely be forever.

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Run that report.

Speaker A:

Every practice I look at has real money sitting in there, not theatrical money.

Speaker A:

Treatment you already diagnosed and the patient already heard about it.

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Two other numbers belong in this conversation because they eat the same production from a different direction.

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Broken appointment rate, I.e.

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Cancellations and no shows as a percentage of scheduled appointments.

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Under 5% is healthy.

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When I see 15%.

Speaker A:

The practice is running a leak in the middle of the day, not just at the end of a visit.

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And the fix is a confirmation process that is a real conversation rather than an automated text nobody reads.

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Plus a short call list of patients ready to fill an opening on two hours notice.

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And your hygiene schedule fill rate.

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Your hygienists are the engine of continuing care and the primary source of diagnosis for your practice.

Speaker A:

Open time and hygiene is not a slow day.

Speaker A:

It is a production that never comes back.

Speaker A:

Every one of these four breakdowns is a behavior.

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It is not one of them.

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I should say not one of them.

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Requires you to spend a dollar to fix again.

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Everything I've told you so far stops the leak going forward.

Speaker A:

Now, let me talk about the money already on the floor.

Speaker A:

There's a list in your practice management software right now of patients who used to come in and have stopped.

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Every practice has it.

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But I will tell you right now, nobody works it.

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It is the most underworked asset in your building.

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Understand who these people are.

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Because owners get this wrong.

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They're not unhappy patients.

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Very few of them left because they were upset with you.

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They trusted you enough to come in, sit down, and they let you treat them.

Speaker A:

The problem is, then life happened.

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A job changed, insurance changed, a baby arrived, they moved 15 minutes farther away.

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They had a hard year.

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The dentist slid down the priority list and just nobody ever reached back out.

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Most of them simply forgot.

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They're not trying to avoid you.

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They're waiting to be reminded.

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And the reminder never came.

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Here's how you actually work that list.

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And I want to be specific, because this is where practices fail.

Speaker A:

A mass email blast to everybody is not a reactivation campaign.

Speaker A:

That is a coupon nobody asked for.

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Real reactivation is a structured sequence run against a clean list by a person whose job it is.

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Start by building the list properly.

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Pull every patient with no future appointments whose last Visit was between six and 36 months ago.

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Then clean it.

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Remove the patients who moved out of the area, the ones who transferred with a records request, and the ones who are who have passed.

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A dirty list.

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All it's going to do is waste team hours and kills their belief that this project will happen in seconds or later on in the afternoon.

Speaker A:

Then split what is left into three tiers because they are not the same people.

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Tier one is six to 12 months overdue.

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These are the warmest names, and they are barely gone.

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Most of them think they are still your patients, and honestly, they are.

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This tier converts the fastest and you work it first.

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Tier 2 is 12 to 24 months.

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Still very warm.

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They know your name, they know where you are, and they remember their hygienist.

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Tier 3 is 24 to 36 months.

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Now, this is lower conversion.

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Still absolutely worth the call.

Speaker A:

And this tier is often where you find the biggest single cases, because a lot can go wrong in three years without a dentist.

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Now, the sequence and the order matters.

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Text message first, because it gets read.

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Then email a few days later with a little more substance.

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Then the phone call.

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And the phone call is the workhorse of the entire campaign.

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That's where you're given a live Human voice saying your name is what actually brings people back.

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Text and email warm them up so the call is expected rather than cold.

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For Tier 3, add a physical letter.

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Because almost nobody gets mail from their dentist anymore.

Speaker A:

So it may stand out.

Speaker A:

The language is the same principle as the chair.

Speaker A:

Warm, direct, no guilt, no pressure.

Speaker A:

It sounds like this.

Speaker A:

Hi Sarah, this is Michelle from Dr. Andersen's office.

Speaker A:

I was going through our schedule and realized we have not seen you in about a year and a half.

Speaker A:

And I wanted to make sure you did not fall through the cracks on us.

Speaker A:

We would love to get you back in.

Speaker A:

I have.

Speaker A:

Tuesday the 18th at 10 or Thursday the 20th at 2.

Speaker A:

Wednesday.

Speaker A:

Which one works better?

Speaker A:

Notice there's no apology.

Speaker A:

There's no lecture about how long it's been.

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And no open ended question about whether they would like to come in sometime.

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Two specific times.

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One decision.

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And give them a reason.

Speaker A:

The timing is now.

Speaker A:

It has been long enough that you are due for updated radiographs.

Speaker A:

Your insurance benefits reset in January and most of that is going to expire unused.

Speaker A:

We're holding some time next week specifically for patients we've not seen in a while.

Speaker A:

Any one of those turns someday into this month.

Speaker A:

Let me show you the math because the math is what makes owners.

Speaker A:

Assign this to somebody on Monday.

Speaker A:

Say your clean list is 400 names.

Speaker A:

Work it properly through the full sequence and you should expect somewhere between 15 and 25% to come back in.

Speaker A:

Call it 80 patients.

Speaker A:

80 Patients times an average first visit.

Speaker A:

Somewhere around $300 for the hygiene appointment and radiographs is 24,000.

Speaker A:

But this is not where the value is.

Speaker A:

A patient who has been away 18 months usually needs something more, right?

Speaker A:

So figure a meaningful share of those 80 produced restorative treatment on top.

Speaker A:

Now you're talking about a number well into six figures out of a list.

Speaker A:

Your accountant would tell you.

Speaker A:

Well, they would say it's worth zero.

Speaker A:

And your acquisition costs on every single one of those patients is zero.

Speaker A:

You already paid it years ago.

Speaker A:

It was spent.

Speaker A:

There's no marketing spend.

Speaker A:

There's no ad platform.

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There's no agency fee, no lead costs.

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There's a person, a phone and a list.

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Reactivation is the highest return activity in your building.

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And almost nobody does it consistently.

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Not because it's hard, but because it's nobody's job until you make it somebody's job.

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So make it somebody's job.

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Name the person.

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Block the hours on their schedule.

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Three hours a week minimum protect time where they are not answering the phone or checking in patients.

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Give them A weekly target for calls made and appointments booked.

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Track the production it generates as its own line so everyone in the building can see it working and then celebrate it out loud in your morning huddles.

Speaker A:

Because the moment your team sees a patient walk back through the door because of a call they made, this project stops being a chore and it starts being a source of pride.

Speaker A:

Let me tell you how this lives on the class dashboard.

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Because a system you cannot see is a system that that you abandoned by the third.

Speaker A:

Week three Numbers watched every month.

Speaker A:

Hygiene reappointment percentage.

Speaker A:

So you see the leak closing in real time instead of hoping it is.

Speaker A:

When that line moves from 70 towards 95, you're watching the future of your practice change while it happens.

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Active patient count.

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So you know the true size of your practice is growing rather than shrinking.

Speaker A:

This is the number that tells you whether your marketing dollars are building something or they're just replacing what you lost.

Speaker A:

And reactivation production tracked as its own line so you can see the exact dollars that came back from patients you had written off.

Speaker A:

Not an estimate.

Speaker A:

The real number.

Speaker A:

An owner opens the class dashboard and sees the foundation of the practice getting healthier month by month over month.

Speaker A:

This is the difference between hoping recall is working and then knowing it is.

Speaker A:

Before I let you go, here's exactly what to do with all of this.

Speaker A:

Four weeks in order.

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Week one.

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Measure.

Speaker A:

Pull your hygiene reappointment percentage, your active patient count, and your unscheduled treatment report.

Speaker A:

Do not fix anything.

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Just find out where you actually stand and share the numbers with your team.

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And don't blame anybody.

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This is a system problem, remember?

Speaker A:

This is not a people problem.

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And it matters that your team hears what you say.

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Week 2 Install the 90 seconds.

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Write the scheduling language down, word for word.

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Practice it in a team meeting out loud, because reading a script silently does not change behavior.

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Set the standard that nobody leaves hygiene unscheduled and build the verbal handoff into every appointment.

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Then week three, Build a list.

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Pull your reactivation list, clean it, tier it, and assign it to a specific person who has protected hours on their schedule.

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Week four, Run it and watch it.

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Start the sequence.

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Track calls made and appointments booked, and post your reappointment percentage where the whole team can see it.

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Every week that is is 30 days.

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No capital, no new hire, no new marketing spend.

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And by day 30, you will already have patients back in the chairs who were not, I should say, coming back at all.

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Now here is the honest part.

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And I say this to every owner I meet.

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You have two choices with everything I just gave you, you can go back to your practice, try to install it on your own and hope it sticks.

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Some owners do exactly that and make it work, and I respect that.

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But I'm going to tell you what I see far more often.

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Week one is strong.

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Week two is decent.

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Then a hygienist calls in sick, the schedule blows up, somebody quits, and by week five is quietly back to how it was and nobody ever mentions it again.

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Or you can let a coach who has installed this hundreds of times do it with you, hold you and your team to it for accountability, and show you the numbers moving on your dashboard every single month.

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Recall and reactivation is a system, and systems stick when a coach installs them and holds the team accountable to them.

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:

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If you are not ready for a monthly coaching relationship yet, well, start with our practice health assessment and we take one deep look at your practice across every number that matters and we hand you a written plan of what to fix first.

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It's the fastest way to find out where your money is leaking.

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The assessment will show you your active patient count, your reappointment percentage, and how much production is sitting in your reactivation list right now.

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Whichever door you walk through, you land on the class dashboard.

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That is the single view of your practice that every class coach works from and is where you will watch those numbers improve.

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Check us out@classdentalcoaching.com or book a discovery call.

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We'll tell you exactly where you stand.

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That is the show.

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Go pull yesterday's hygiene schedule and count will take you 10 minutes and it will tell you everything.

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If this helped, share it with an owner or a friend of yours who needs it and we'll see you next week.

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About the Podcast

Dental Business
Strategies for Growth to Build your Dream Dental Practice
This podcast is a community of dental professionals who share their knowledge, expertise and experience in order to provide value to you and your dental practice. Our topics will cover practice management, transitions, real estate, accounting, law, financial planning, dental product reviews, marketing and much more! We welcome you to visit us at (https://www.klassolutions.com) to learn more about how we can help you build your dream practice.

About your host

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Philip Cole