Associate DISC Profile Test

First Name: Last Name:

Consider the 10 groups of words below while thinking about you

Instructions: rank the words by assigning 4 points to the word that is mostl lik
somewhat like you, and 1 point to the word that is least likeyou

Section 1 (select number from drop down)

Enthusiastic

Bold

Conscientious

Friendly

Section 2 (select number from drop down)

Logical

Attractive
Good-Natured

Outspoken

Section 3 (select number from drop down)

Agreeable

Outgoing

Daring

Careful

Section 4 (select number from drop down)

Strong-Willed

Tactful

Sympathetic
Charming
Section 5 (select number from drop down)

Gentle
Well-Disciplined

Talkative

Pioneering

D 0 #DIV/0!

I 0 #DIV/0!

S 0 #DIV/0!

C 0 #DIV/0!

0
SC Profile Test

Date: Tuesday, April 30, 2019

while thinking about yourself in a selected focus (e.g., work, home, or school). In each group,
the word that is mostl like you, 3 points to the word that is like you, 2 points to the word that is
word that is least likeyou. (Select the point number from drop down lists)

Section 6 (select number from drop down)

Competitive
Click
Even-Tempered

Good Mixer NEXT

Thorough

Section 7 (select number from drop down)

Sociable

Dominant
Controlled

Easy Going

Section 8 (select number from drop down)

Reserved

Appealing

Kind

Direct

Section 9 (select number from drop down)

High-Spirited

Amiable

Vigoruos
Accurate
Section 10 (select number from drop down)

Restless
Expressive

Diplomatic

Considerate
1

4
 Associate Profile Questionnaire

First Name: Last Name: Today's Date: 4/30/2019 Partnership

Ownership
Both
Top 3 Dental Procedures that interest you

What do you want from an office? 1 2 Other?

Do you need or want benefits?

Click
Do you want a full-time or part-time Associatship?

Are you interested in a partnership or future ownership?

BACK

What are your short-term goals? 1 Year? 5 Years?

Where do you see yourself in the future?

Desired location (please choose at least two) 1 2 3 4 5

Desired Compensation

Dental Software Experience 1 2 3 4 5 Other

Production Reports # of Molar Endo # of prosthesis cases

Please fill in your production reports for your clinical dental school information to date.
(Example: 40 crown preps that you actually completed in your two years of clinical
experience.) *** Actual production reports need to be emailed as part of your
application in addition to this questionnaire.)

# Crown Preps completed Invisalign cases started # of CAD/CAM cases

# of Implants Placed Invisalign cases complete # of implants restored

Amount of time needed from start to finish for: Crown prep Crown Seat

Implant placement Class IV filling

Implant restoration Ant. Aesthetic for 2 teeth

CAD/CAM Hyg Exam New patient

Hyg exam for periodic exam

For Consultant Use Only***

Click on Graph for DISC results

DISC Sheet (click Logo)

Chart Title
 Profile Totals

le D0

0I

S
0

C0

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

s

0.6 0.7 0.8 0.9 1