Aesthetic Advisors · Practice Diagnostic Intake
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Practice Diagnostic Intake
Confidential · Hopkins Aesthetic Advisors LLC · Please complete this form prior to your consultation. Your responses will be sent directly to Danna Hopkins.
Confidentiality Notice
All information shared in this intake form is strictly confidential and will be used solely to prepare for your consultation with Hopkins Aesthetic Advisors. Your responses will not be shared with any third party, competitor, or external organization under any circumstances. This form is protected under our mutual confidentiality commitment — the same standard we maintain throughout every client engagement.
01
Practice Overview & Current State
Understanding the baseline before identifying opportunities
Revenue & Volume
What is your approximate annual gross revenue?
How would you describe revenue trend over the past 2 years?
What is your approximate monthly surgical case volume?
Non-surgical / aesthetic treatments/month:
What are your top 3 revenue-generating procedures?
1. 2. 3.
Practice Structure
How many full-time staff do you currently employ?
Clinical: Administrative / Front Office: Patient Care Coordinators: Management:
Do you have a dedicated Practice Administrator or Office Manager?
Are you currently accredited? If so, by which body?
02
Pain Points & Frustrations
What's not working — and where you feel the friction
Current Challenges
What is the single biggest operational challenge you're facing right now?
Which of the following are active pain points in your practice? (Select all that apply)
On a scale of 1–10, how much of your time is spent on business operations vs. patient care?
All patient care
All operations
Have you worked with a consultant or practice management advisor before?
03
Financial Health & Visibility
What you know about your own numbers — and what you don't
Financial Awareness
Do you know your practice's profit margin?
Do you track revenue per procedure or revenue per patient?
When did you last review and update your fee schedule?
Do you have a monthly financial dashboard or P&L you review?
Do you know your consult-to-surgery conversion rate?
Estimated conversion rate: Formally tracked?
04
Goals, Vision & Priorities
What success looks like — in your words
Short & Long Term Vision
If we work together and it goes exactly as you'd hope — what does your practice look like in 12 months?
What is your 3–5 year vision for this practice?
Have you received acquisition interest from PE-backed groups or DSOs / consolidators?
What would "winning" look like for you personally in this engagement?
05
Expectations, Budget & Timeline
Aligning on what's realistic — before commitments are made
Expected Outcomes
What specific outcomes are you expecting from a consulting engagement?
How will you measure whether this engagement was successful?
Are there any outcomes that are non-negotiable or deal-breakers for you?
Budget
Do you have a budget range in mind for advisory services?

Select a one-time or monthly range — whichever feels most relevant to what you have in mind.

One-Time / Project
Monthly Retainer / Ongoing
How does the practice typically make investment decisions — physician only, or does a practice manager / spouse / partner weigh in?
Timeline & Urgency
What is driving your timeline — is there urgency here?
When would you ideally like to begin?
06
Team, Culture & Staffing
The people side — often where the biggest problems hide
Team Health
How would you rate overall staff performance and morale?
Very poor
Excellent
What has your staff turnover been like over the past 12 months?
Do you have written job descriptions, compensation plans, and performance review processes?
Is there anyone on the team who is likely to resist operational changes?
07
Patient Experience & Conversion
From first inquiry to booked procedure — where patients are lost
Patient Journey
How do most new patients find your practice?
What happens when a new patient calls or submits an inquiry — walk me through your intake process.
How quickly does your team typically respond to a new patient inquiry?
Do you use a CRM to track leads and consults?
EMR / Practice software used:
After a consult where the patient doesn't book — what follow-up process exists?
08
Competition & Market Position
How you see your market and where you stand in it
Competitive Landscape
Who do you consider your primary competition in your market?
Are PE-backed or corporate aesthetic practices active in your market?
How would you describe your practice's competitive positioning?
What do you believe your patients choose you over competitors for?
09
Expansion, Accreditation & Special Projects
Bigger initiatives — where significant investment and risk live
Expansion Plans
Are you actively considering opening a second location or ASC?
Have you started any site selection, lease negotiation, or design work?
Accreditation
Is accreditation (new, renewal, or upgrade) on your agenda?
Target accreditation body: Survey target date:
10
Working Relationship & Fit
How you work best — and whether this is the right fit
Working Style
How involved do you want to be in the implementation of recommendations?
How does your team typically respond to change?
What is your preferred communication style during an engagement?
Effective advisory work often requires access to financial reports, practice management software, EMR data, and operational systems. How comfortable are you providing that level of access?

All information accessed is held in strict confidence under our mutual confidentiality agreement.

Is there anything that would make this engagement not work — from your side?
Is there anything about your practice or situation that you think I should know, that we haven't covered?

🔒  Your responses are strictly confidential and sent directly to Danna@hopkinsaestheticadvisors.com