Please take a few minutes to complete this form so we have all the information we need to promote your practice!

Personal Cell Phone *

We need your personal cell phone in case we need to contact you directly. We won't send promotions or spam or resell your personal contact information. Your privacy is GUARANTEED.

Legal Business Name *

Practice Facebook Page

Practice Phone Number *

Main Office Address *

Employer Identification Number (EIN)

You can find your EIN on previously filed tax returns or by calling the IRS at (800) 829-4933. Your EIN is required by law to confirm your call tracking number and to send automated text messages.

Number of Practice Locations *

Multiple Location Addresses

Practice Specialties (Check all that apply) *

Services You Provide (Check all that apply) *

Any Other Services You Provide?

Discounts/Offers/New Patient Specials

It's best to have a minimum of 3 special offers ready to go. Once one offer loses traction, we can promote your next offer, so we're able to send you a consistent stream of qualified leads.

Do You Have Giveaways?

We need access to your logo, photos and videos of your practice. Right click (control click on Mac) on the appropriate folder(s) and share your media files with [email protected].

Add us as a Partner in Meta Business Suite so we can manage your Facebook Ads.

Click Partners in the navigation column.
Click Add and select Give a partner access to your assets.
Copy and paste our Business Partner ID: 333820929403095
Click Next.
Select the Business Page you want to give us access to.
Scroll to the bottom of the window and select Full control (business pages and Facebook).
DON'T SAVE CHANGES YET

Select Add Accounts in the left menu.
Toggle Full control Manage ad accounts.
Select Pixels in the left menu.
Toggle Full control Manage Pixel.
Next, select Instagram accounts in the menu.
Select your Instagram account.
Toggle Full control Everything.
Click Save changes.

Facebooks Ads Account Billing

If you've already added a payment method to your Facebook Ad Account this step is unnecessary.

Click the appropriate account.
In the left menu, click Payment Methods.
Click Add Business payment method.
Enter your card information and save.

Google Business Profile

Click on the three dots.

Select Business Profile settings.
Select People and access.
Click Add.
Copy and paste email address: [email protected]
Select Manager.
Click Invite.

Office Manager/Front Desk

The person you want us to send leads and appointment notifications to.

Name of Office Manager or Front Desk *

Office Manager/Front Desk Phone Number *

Office Manager/Front Desk Email *

Does Your Front Desk Speak Spanish?

Website Administrator

We need access to your website in order to install tracking code, custom booking calendars, and website chat.

Web Admin Phone Number

What Practice Management Software Do You Use?

What is Your Monthly Advertising Budget? *

Click the link to visit our website and purchase your service plan.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.