Hospital Profile Worksheet

Top 3 Goals

These are meant to be a snapshot of your current goal focus areas and may change as we identify areas of opportunity through the plan of action process.

What results do you expect to see in your practice within six months of joining iVET360?(Required)

Company Name

Official Name:

Exactly as it should appear in any official documents or applications

Marketing Name:

Exactly as it should be listed on all marketing or other public facing materials

Practice Management Software:(Required)

Accounting Software:

Ownership

Business Title

Ownership Tenure

Share %

Add a Second Owner?

Yes

Business Title

Ownership Tenure

Share %

Add a Third Owner?

Yes

Business Title

Ownership Tenure

Share %

Add a Fourth Owner?

Yes

Business Title

Ownership Tenure

Share %

Add a Fifth Owner?

Yes

Business Title

Ownership Tenure

Share %

Location(s) Information

Total Number of locations:

Primary Location Name:

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Second Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Average Fee Percentage Increase Over Course of Year (excluding shoppable fees)

Add a Third Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Fourth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Fifth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Sixth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Seventh Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Eighth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Ninth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Tenth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Eleventh Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Twelfth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Thirteenth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Fourteenth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Add a Fifteenth Location?

Yes

Location Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Fax

Website

Primary Contact

# of Staff

Estimated Full-Time Equivalent DVM for Previous Year:

(How do I calculate this?)

Number of Exam Rooms

Square feet of leased/owned space

Management Staff Information

Please list details for staff in a management role with in the practice.

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Second Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Third Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Fourth Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Fifth Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Sixth Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Seventh Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Eighth Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Ninth Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Add Tenth Management Staff Member?

Yes

Name

First Last

Role

Start Date

Certifications

Notes (Optional)

Return to Form List