You may have heard me mention Dr. Brad Durham’s Niche Practice Seminars before. If you have, then this article will be an important review for you. If you haven’t, this is a nice sneak peak. You can learn more here. Dr. Strickland also teaches a version of this in his Online Course FOY® Dentures seminar.

In the Niche curriculum, dentists are taught the acronym N-A-S-T-C. It stands for:

  1. N eed
  2. A nswer
  3. S ource
  4. T ime
  5. C ost

In all their years of building a successful niche cosmetic practice, Dr. Durham and Dr. Strickland have learned that they can get more patients in the door who are ready to sign on the dotted line for $20,000, $30,000, $40,000 or $50,000 cosmetic dentistry cases if they will follow this protocol of Need » Answer » Source » Time » Cost. In the above list, I numbered these steps because they should be addressed sequentially. I highlighted Cost because, while it is an important step in getting agreement with the patient about whether or not they are going to be a good patient in the practice, it should not be addressed first. Yet in so many offices, Cost is the first and only step in conversations with prospective dental patients…and it is costing these practices millions of dollars.

5 Gilded New Patient Qualifiers

Let’s go over each of these steps to learn what they represent and why they are so important. These are designed to be used in consultations and case presentation, but a stripped down version of them can be used on the phone to qualify patients.


The is so simple and yet so critical to getting buy-in from patients on agreeing to the treatment that they truly need and desire rather than settling for a poor substitute.

What is the patient’s actual need?

If the patient does not understand the severity or root cause of their need, then the exceptional quality of what you have to offer may be lost on them. The patient may say that they need a new denture, but that’s not really their need. Is their need to look younger? Is their need to get out of pain? It’s your job as a team to dig deep and find out what is really motivating them. Get to the root of their values and it will be much easier for them to then believe that some mass-produced hunk of plastic that looks terrible and hurts when they chew is not what they need after all. Clarify what it is they think they need. Explain what others in your practice have decided that they need (what you have to offer) and why they felt that way.

This may sound something like:
Doctor: Mrs. Smith, what made you contact our practice today?
Patient: I need a new denture.
Doctor: We certainly offer dentures. Why do you think you need a new denture?

Patient: I’ve had this denture for years and I just think it’s time for a new one.

Doctor: I understand. What kinds of issues are you having with the denture? Are there things you don’t like about it?

Patient: Well, it’s just kind of hard to eat.
Doctor: Mrs. Smith, we hear that a lot. Many of our patients are looking for improved function. Many also don’t like the way their dentures look. They say things like, “My dentures make me feel old.” And they hate the sunken in denture look that they have since getting their dentures. Are there any issues like that that you’re having?

Patient: Well, sure. But I mean, I wear dentures, so what are you going to do?
Then try to reconcile those two points of view. If the patient realizes that they actually do have a need, then you can proceed.



What is the answer to the patient’s problem? You and the patient need to be in agreement on this. If you believe that the answer is an implant-supported bridge, obviously the patient will not move forward with treatment unless she agrees. This agreement doesn’t happen by chance. It takes exploration and education and probably isn’t something that you can fully address in an initial call, but some qualification will naturally take place toward this end with questions like, “Are you just interested in fixing this one issue, or are you looking for a new dental home?”

Once the patient is in the office, you can explore their Need and then present options for addressing the Need (again the need is not the treatment but the actual problems that the patient is faced with) that both you and the patient can live with. Identify which Answers make sense to the patient, then you can move forward with the sales process to start narrowing the choices.


Are you the dentist for the job? If the patient believes that they have a true need and that the answer is what you are offering but isn’t sure that you’re the person to provide the solution, the treatment won’t move forward. This comes down to establishing trust. You, the doctor, as well as the practice at large need to establish credibility from the beginning of the relationship and be attractive as a provider – worth every penny of the service that you offer.

You have an attractive website, but does the rest of the practice match the image that you portray online? If not, closing leads from marketing and referrals will be a struggle. Think about what it’s like to walk into a store or dealership for a high end brand and how it matches their marketing.

Again, you can’t fully address Source in an initial call, but you can gather some information asking, “What made you decide to call us today?” The patient’s answer can give you some clues to their values. Have your team ask the question, take note of their answer, and be sure to use this information during the consult and case presentation.


Is the patient willing to commit the time to the appointments required for the treatment? If they are looking for an instant solution, they need to be willing to adjust their expectations before moving forward with treatment. If you don’t have understanding and agreement on this, they may not appreciate the investment or the complexity involved. This can blow up in your face later and result in unfinished treatment and negative reviews online.


Most offices put this at the front end of the conversation. Patients do this too and unless your team is trained to adapt and redirect the conversation back to the beginning of NASTC (Need), then you will struggle with booking appointments as well as case acceptance. Everyone wants to know how expensive treatment is- even people with the funds to pay for it regardless of the cost. This does not mean that cost should be the most important topic nor the first topic that we discuss with a patient.

Until we understand Need, Answer, Source and Time, how can we really quote a fee? And until a patient fully understands their Need, what their Answer is, who they are getting the answer from (Source), and how much is involved to get the solution (Time), how can they possibly see that the cost involved is reasonable. Sticker shock happens when you skip ahead in this NASTC sales process and when there’s a mismatch in values. Brad Durham and his team do a tremendous job in coaching values clarification. I would love for all of our members to attend his seminars or at least buy their DVD series.

If a patient absolutely will not schedule a consultation without a dollar amount in their brains, give them a HUGE range. How much is a dental implant? “Well, as I’ve said, we really need to get you in for a consultation so that we can assess your needs and what the proper solution is for your unique dental problems, but with the information you’ve provided, all I can say is that dental implants can range from $1,500 to $6,000 per tooth. If you’re available to come into the office, we’d be happy to provide you a more accurate cost of treatment after we have seen you.” Do not quote specific fees over the phone. It’s not something that you don’t do as a policy- it’s something that you cannot do.

Putting N-A-S-T-C Into Practice

Until you see a patient, you don’t know the patient’s need. The patient doesn’t really know their need either. So how can you possibly quote a cost for treatment?? If your team member answering the phone caves under pressure and blurts out a number, the patient will either call somewhere else until they find a cheaper quote (again, even a wealthy patient may do this) OR the patient will come in holding onto that quote for dear life and you’ll be stuck having to explain that, “Yes, the fee we quoted is accurate, but you also need this, that and the other thing.”

The patient will view this as nothing short of a bait and switch. Don’t bother trying to explain this conundrum to a patient. Just stick to your guns: “I’m sorry but we cannot quote a fee for treatment until we can see you and know what the treatment plan will be.”

So, next time a patient calls and asks, “Yeah, hi, I’m just calling to find out how much you charge for a crown,” redirect.

“Thanks so much for calling. Who am I speaking with?… Hi Jerry, I’m curious how you found our office?… Oh, our website? That’s great. Well you mentioned that you need a crown, is that the only issue that you need to have taken care of or are you looking for a new dental home?” [Jerry says he just needs a crown.] “That’s interesting Jerry. You know, we are a little different than most dental offices. We take the time to understand a patient’s needs through an in-depth evaluation of their oral health. Usually we find that this goes beyond one surface issue like the need for a crown. Of course, if we find that you truly only need a new crown, that’s what we’ll do, but we like to try to figure out why you need a crown at all in the first place. Is that something that you’d be interested in? [Jerry says, yes, but I’d like to know how much it costs.] “Well Jerry, our new patient exams are just $99 and if you end up moving forward with treatment, we’re happy to apply that toward the cost of the treatment plan that you and the doctor agree upon. I see a couple of openings for new patient appointments here on our schedule. I have tomorrow at 3pm and Thursday at 9am. Which would work better for you?”

The goal is to get these people scheduled- not necessarily to take them through the entire sales process.

When I listen to calls at the various offices that we work with, I find myself thinking about this NASTC approach and wondering what kind of a difference it would make in their practice’s bottom line if they kept this in mind when they answered their phones and when they have patients come in for consults. It feels like a game changer to me. If you have more questions about this, I’ll be happy to connect you with Brad and Rod and their team. They really are amazing.