Marketing Intake QuestionnairePlease enable JavaScript in your browser to complete this form.Name of Practice *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeName of practice owner *Contact Email *YOUR UNIQUE POSITION What do YOU do that is truly great? Better than all other dentists in your area? *How does this great thing benefit your target market? *Who is your target market? *Is there something (service or therapy) you want to offer to patients that you currently do not? If so, What? *What do patients really “HATE” that you can fix? *What are your patients’ greatest FEARS? *If asked, what would your patients say is AMAZING about your practice? *Describe your personality or the persona you wish your patients to see more of. *What is something you think your patients DO NOT know about you but should? *What are you currently known for in your community (market)? *What type of New Patient do you want (your ideal patient)? *YOUR COMPETITORS Describe your biggest competitor *What do they do better than YOU? *CURRENT MARKETING IMPLEMENTATION Where do your current New Patients come from? *Please indicate what percentage of new patients come from: Existing patients, Google search, Other Marketing, Referred by others than patients.Do you want more New Patients? *How many 5-star Google reviews do you now have? *Do you want more 5-star Google reviews? *What else would you like to accomplish with a patient communications/email/newsletter system? *What Practice Management Software do you currently use? *What patient communications system(s) do you currently use? *Who is responsible for implementing patient communications? *How often are you routinely communicating with your existing patients? *How is it currently done? *What other marketing do you currently do? *Please explain the message, the media used and target market.How much do you currently spend per month on marketing? *WHERE YOUR PRACTICE IS NOW How many new patients did you get in 2018? *How many new patients did you get in 2019? *How many new patients did you get in 2020? *How many active patients did you have in 2019? *Active Patient is a patient who has been in your practice within an 18-month period.How many active patients did you have in 2020? *Active Patient is a patient who has been in your practice within an 18-month period.How many active patients did you have in 2021? *Active Patient is a patient who has been in your practice within an 18-month period.How many active patient email addresses do you have? *How many TOTAL patient emails do you have? *How many referring non-patients do you have? *How many of these non-patient referrers’ emails do you have? *Have you ever sent anything to non-patient referrers? *Do you participate in any insurance plans? *For each, what % of your practice does it represent?Do you know the Lifetime Value of your Patients (LPV)? If so, what is it? *At what capacity are you currently operating? *What is your current practice gross collections? Please check one. *Less than $300,000Less than $500,000$500,000-$1,000,000$1,0000-$2,000,000Greater than $2,000,000WHERE YOU WANT YOUR PRACTICE TO BE Do you have a growth strategy to handle increased patient demand? If so, please explain. *Do you have an EXIT strategy? If so, please explain. *Where do you want it to be in 2 years? *Where do you want it to be in 5 years? *Where do you want it to be in 10 years? *Submit