Marketing Intake Questionnaire - Practice Perfect Systems

Name of Practice *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name 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. *

WHERE 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? *