Orthodontic Project Survey Orthodontic Floor Planning Questionnaire Client Name First Last Suffix Client Billing AddressName and contact Info of leasing agent or property(owner)Building/Space Site Address# of Years in PracticeWhat is the square footage of the space?If leased space when do you payment start?Please list any specific dates we should be concerned about?Name and contact Information of leasing agent or property owner?What is your project total project budget or budget per square foot?What is your tenant improvement allowance from the landlord?Any additional comments about the construction budget?Do you have any contractors in mind for the project?(If yes please list names)Who will be the dental equipment supplier for the project?(Please list names of companies you are considering)How many doctors will be practicing in this office?Are you planning to share this office with a pediatric dentist?Business/Financial Coordinator OfficeHow many work stations do you want in the business office?What will be the function of the work area, insurance, business, patient call backsBusiness office choises Do you want seating in the business office so that parents can sit down to discuss account status I do not want a separate business office Equipment DeskEquipment Desk Choises Do you need a central equipment desk for business machines: credit card processing, copier, postage, printer Or will all business transactions be digital Equipment will be located at individuals workspace CommentsSTAND UP PARENT CONSULT/PATIENT EDUCATIONSTAND UP PARENT CONSULT/PATIENT EDUCATION Do you want a niched parent consult alcove between the treatment bay and reception for a quick parent update on the patients treatment status? I will provide education & parent consulting at chair side. CommentsNEW PATIENT EXAMHow many NPE/TC rooms would you like to haveNEW PATIENT EXAM Fields Will these offices be utilized as a permanent work station for a treatment coordinator Or only used during new patient exams Fully reclining patient exam chair Salon Chair Parent/Patient Accommodation in TbayParent/Patient Accommodation in Tbay fields Will you be providing patient instructions at chair side Or do you want a patient education alcove off the TBay Do you provide patient Education at Chair Side Or do you provide video links to patients to watch from home Do you want a space for parents to sit at the foot of the patient chair If yes, do you want fixed non movable built in seating Or a small chair or foot stool Are you planning on scheduling re-appointments in the TBay Or will all re-appoints be at Front Desk I don’t want parents in the TBay CommentsWork StationWork Station fields Do you want a micro etcher with built in vacuum to be located in the TBay area or close to the TBay Do you need any other type of work station off the Tbay CommentsPatient RewardsPatient Rewards fields Do you want an rewards wall If yes will this be digital Or cork board Do you want an instagram/community wall Gumball Machines Additional TBay CommentsTREATMENT BAY continuedSide Cart PositionSide Cart Position fields 12 o’clock is at patient’s head, 6 o’clock is at patients feet, side cart is at 9 o’clock, typically for right handed practitioners 12 o’clock is at patient’s head, 6 o’clock is at patients feet, side cart is at 3 o’clock (typically for left handed practitioners) Do you want to be able to move the side cart from left to right (this would require an umbilical cord & quick disconnect) CommentsTask Lamp or Overhead LightingTask Lamp or Overhead Lighting fields Will you be using a chair mounted task lamp Will you be using a ceiling mounted task lamp mounted on track Will you be using a ceiling mounted task lamp mounted on mono point Will you be using dental loupes Or do you want to use high output ceiling lights above the treatment chair (room light) TBay TechnologyTBay Technology fields Will the side unit house a CPU with a pole mounted monitor Or will you use a lap top Or will you use an Ipad/Note Pad Do you prefer 1 to 2 computer stations at the TBay work counter, rather than at chair side Do you want TV monitors on the wall at the foot of the patient chair If yes, will these be mounted on the wall at the foot of each patient chair Do you want TV monitors to be ceiling mounted Do you want TV monitors mounted on the side cart CommentsWhat type and size of side cart do you plan to useWhat type and size of side cart do you plan to use fields Small 16"w x 24"l Medium /Standard 24"w x 24"l Large 30"w x 36"l Are you re-using existing Carts WASHROOMSWASHROOMS fields Are public washrooms available If patient washroom is in office do you want high end finishes I want the patient washroom to be functional, clean and simple design Do you want a private doctor’s washroom Do you want a private doctor’s shower CommentsSTAFF LOUNGESTAFF LOUNGE group 1 Will you be using the staff lounge for lunch and educational presentations How many chairs?STAFF LOUNGE group 2 Do you want staff lockers Do you want a dish washer Do you want an insta hot water dispenser Will the refrigerator be an apartment size single door Or full size double door With ice dispenser Water dispenser with filter Do you want a garbage disposal CommentsSTORAGESTORAGE fields Would you like Bulk storage/UPS drop off close to the staff entrance Would you like clinical storage close to Tbay, Sterile & Lab CommentsLAB/3D PRINTINGHow many 3D printers are you planning for?LAB/3D PRINTING fields If planning a full service wet/dry lab what countertop equipment do you plan to use? Single or Dual Wheel Model Trimmer Lathe Pressure Pot Retainer Maker Whip Mix Acrylic Hood Micro Etcher 3D Printers Insta Hot Water Dispenser Large Work Sink Indirect Bonding Desk Compressed Air Plumbed Gas or Portable Air CommentsDOCTOR’S OFFICEDOCTOR’S OFFICE group 1 Would you like your office to be close to the TBay with visibility Or in a more private area I do not want a doctor’s office How many doctors work stations will you needDOCTOR’S OFFICE group 2 Do you want seating for private conversations with staff Or will you use a NPE room for private staff conversation CommentsServer EquipmentServer Equipment Fields Will you need a separate server closet Or will a server cabinet with ventilation slots be adequate CommentsSTERILZATION continuedSTERILZATION continued fields Or Dry heat sterilizers Or hydrim washer Do you want ultrasonic to be on the counter top Do you want ultrasonic to counter sunk Do you want ultrasonic to on under counter mount Would you like a compressed air nozzle above the counter Do you need a water purification system installed under sterilization sink to refill water bottles at treatment chair side unit-reverse osmosis Or will you be purchasing bottled water Do you need undercounter refrigerator for bonding agents in the clean tray area Or in an undercounter refrigerator in the Treatment Bay cabinets CommentsTREATMENT BAYHow many patient treatment chairs do you wantTREATMENT BAY group 1 Will you be purchasing all new treatment chairs Or will you be reusing existing treatment chairs Do you want any of the treatment chairs to be separated by partial or full partition walls If yes, do you want all chairs separate with partitions How many treatment chairs do you want separated?TREATMENT BAY group 1 Would you like to have a doctors command perch in the Tbay Do you want a clinical treatment coordinators perch in the Tbay Do you want touch free faucets at sinks in the TBay If yes do you want if yes do you prefer electronic Or do you prefer Tap Master foot controls Do you prefer a linear treatment bay layout with rear hand washing and supply cabinets Do you prefer back to back treatment bay layout with Islands Do you prefer an “L-shaped treatment bay layout Do you prefer a curvilinear Treatment Bay layout NEW PATIENT EXAM continued group 1 Fully reclining patient exam chair Salon type chair If you plan to use these rooms for overflow treatment do you want a side or rear cart with air and vacuum Do you want a sink in the NPE / TC room How many guest chairs do you want for parents/familyNPE / TC Room continued Do you prefer a peninsula desk with a rounded end, we refer to this as the huddle desk, where the doctor sits at the curved edge Do you prefer a rectangular desk where doctor and assistant sit across from the parent/patient Or do you stand during the presentation CommentsIMAGINGIMAGING fields What type of X-ray equipment will you be using: Pan-Ceph, ICAT or other? Pan-Ceph ICAT CommentSCANNINGSCANNING fields Will you be using a portable hand held device for scanning Or a portable Itero type floor unit on casters STERILZATIONSTERILZATION group 1 Will you be purchasing prefab modular sterilization cabinets Or do you want Green Curve to design the sterile layout for you Will you be using a cassette system How Many sterilizers do you want to plan forSTERILZATION group 2 Do you want sterilizers to be stacked one above the other Or side by side Will you be using steam sterilizers Will you be using dry sterilizer without steam Tell us about this office locationoffice location fields Satellite Office Main office Ground Up building shell Leased space in a medical/dental plaza Leased space in a professional plaza Lease space in mixed use retail/business center Stand alone bank building converting to Ortho Office Stand alone restaurant convert to Ortho Office Stand alone professional/medical building Is this a multi story building If multi story, which floor is your office locatedoffice location fields 2 Will you own the building or office condo RECEPTION ROOMRECEPTION ROOM fields Is there shopping close by where parents can go while the patient is in treatment Is this office is located in a rural or semi-rural area where parents tend to bring in the additional family members Do you want a separate children’s area in the reception room Would you like a refreshments counter in the Reception Room Would you like a place to hang coats Comments Δ
