Full Name *

Personal Phone *

Business Name

Office Phone *

Business Address *

City *

State *

Postal code *

What are the cities/zip codes/areas you want your leads coming from? *

Website *

What offer(s) have you used in the past to get new clients through the door? *

Please provide a list of emails that should be notified when new leads come through and who should have access to the follow up dashboard. *

Here are a few ideas for images that will make your campaign successful: • Headshots of the dentist(s) • Photo of the outside of the clinic’s building or sign •Photo of the front desk (with employees is best) and/or the waiting area • Photos of dentist with patient •Group staff photos “Real” photos are always better – photos that are taken on cell phones and don’t have a professional feel are what work best. Blue skies for outdoor photos and good lighting for indoors are helpful, but not necessary.

Please email any photos /marketing collateral that you have to [email protected] *

Done.

I need some help with this.

Do you have a system for appointment reminders? (If yes, will you be adding any appointments we schedule to that process or should we send appointment reminders) *

How long are the initial appointments for: a new regular dental patient, Invisalign, and OrthoFX? *

Which link(s) will we be using to book appointments for you? *

Are there any pre-appointment instructions we need to give out? (If yes, what are they?) *

What are the prices of your services (ie: regular dental cleaning, Invisalign, braces, OrthoFX, etc) *

Which insurance providers do you accept? Do you accept state insurance? *

What financing programs do you offer patients? What is the lowest possible payment a patient could expect?? *

What discount programs do you typically always offer? *

What are the cross streets of your location? How do you describe it when someone asks where you're located? (Ex: near McDonald's on the corner of Jackson and Wolf) *

On the next page you will be able to book your onboarding appointment. The sooner the better because we will need some time to build your campaign out.