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Marketing Intake Questionnaire




YOUR UNIQUE POSITION






YOUR COMPETITORS






CURRENT MARKETING IMPLEMENTATION



Please indicate what percentage of new patients come from: Existing patients, Google search, Other Marketing, Referred by others than patients.
Please explain the message, the media used and target market.



WHERE YOUR PRACTICE IS NOW



Active Patient is a patient who has been in your practice within an 18-month period.
Active Patient is a patient who has been in your practice within an 18-month period.
Active Patient is a patient who has been in your practice within an 18-month period.
For each, what % of your practice does it represent?



WHERE YOU WANT YOUR PRACTICE TO BE



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