First Name *

Last Name *

Phone *

Email *

1. How quickly are you looking to bring new patients into your practice? *

Immediately

Within the next 30 days

In the next 2–3 months

Just exploring options

2. Do you currently have a marketing system that brings in new patients consistently (without relying on referrals)? *

Yes

No

3. What’s your monthly budget for patient acquisition (marketing + implementation)? *

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