Contact and Clinic Info
First Name
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Last Name
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Phone
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Email
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Clinic or Business Name
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Website URL
Clinic Location(s)
Revenue Goals and Targets
Current monthly revenue (approx)
Monthly appointment/booking goal (next 60–90 days)
Annual revenue target for the next 12 months
Services and Pricing
What services do you offer and what is their pricing?
Which services are your top growth priorities?
Comprehensive Bloodwork
Medical Weight Loss (Semaglutide)
HRT
Aesthetics (Botox, Fillers)
IV Therapy
Other
What is your average revenue per new client (first 90 days)?
Offers and Promotions
What current front-end offers are you running?
Which offers have performed best — and why?
Have any offers underperformed? What do you think caused that?
Do you run seasonal/special event promotions? (e.g., Valentine’s, Summer Glow, etc.)
Yes
No
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Lead Gen and Ad Performance
Which channels are you using for lead generation?
Meta Ads
Google Ads
Organic Social
Referrals
Other
How many new clients have come in via marketing in the past 30 days?
Estimated cost per new client right now?
Do you have conversion tracking in place? (FB/Google pixels, offline events, etc.)
Lead Handling and Follow-Up
How is your front desk or team currently managing new leads?
Manual calls
Text automation
Email automation
CRM Pipeline
Other
Average lead follow-up time (minutes/hours)?
Do you have reminder or drip sequences set up?
Yes
No
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Do you struggle with no-shows or lost leads?
Database Reactivation
Do you have a CRM or list of past leads/clients?
How many active contacts do you have? (last 12 months)
How many inactive or unconverted leads are in your system?
Have you ever run a database reactivation campaign?
Yes
No
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What reactivation methods have you used?
SMS
Email
Voicemail Drops
Other
Operations and Capacity
How many appointments can your clinic handle per day?
Any staffing constraints that limit your growth right now?
Budget and Readiness
What is your current monthly marketing/ad spend?
What monthly budget would you feel comfortable investing over the next 6 months?
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$3,000–$4,999
$5,000–$6,999
$7,000–$9,999
$10,000+
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If our proposal meets your needs, when would you ideally like to get started?
Immediately
Within 1–2 weeks
Next month
Need more internal approval
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Final Notes and Consent
Anything else you'd like us to know before we meet?
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