First Name
Last Name
Title
Mobile Phone Number
Email
*
Practice Name (as displayed in Google Profile)
Website URL
Who Are Your Top 3 Competitor?
List All Locations / Addresses For Your Practice (including zip codes)
Is the Address(es) You Listed for Your Company a Residential Address, Virtual Office, PO Box, or True Physical Business Address?
Can You Receive Mail at the Address(es) listed?
Can You Receive Mail at the Address(es) You Listed
Yes
No
No elements found. Consider changing the search query.
List is empty.
Is the Above Address(es) Shared By Another Company?
Is the Above Address(es) Shared By Any Other Companies
Yes
No
No elements found. Consider changing the search query.
List is empty.
List All Company Practice Numbers (and associated location)
Does the Phone #Above Have Call Tracking ?
Does the Phone Number Above Have Call Tracking
Yes
No
No elements found. Consider changing the search query.
List is empty.
Is the Main Business Phone a Landline, Virtual, or Mobile?
How Many Employees Do You Currently Have?
Date Company Was Started
What Hours is Your Business Open
What Methods of Payment Does Your Business Accept
If Required to be Licensed By a State or National Association, How Long Have You Been Licensed?
Please List any Industry Associations You Belong To & Pertinent Details (license #'s, year joined, etc)
Website User Name
Website Password
Where is Your Domain Registered
Website Hosting Company
Hosting Account User Name
Hosting Account Password
FTP User Name
FTP Password
Email for Customers To Contact You
What Marketing Specific Resources (People) Do You Have Internally? Do They Support You Full Time? Part Time? Contractor?
What Websites Do You Use/Trust for the Best Information in Your Industry?
Are You Currently Doing Anything To Acquire Links For Your Website (Yes/No)?
To Your Knowledge has Your Website Ever Been Penalized or Received any Warnings From Any Search Engines (Yes/No)?
Has Any Previous Agency/Staff Conducted SEO Related Work on Your Behalf (Yes/No)?
Do You Have Any Reports/Work Done By Previous Agency/Staff and if so Can You Email Them (We don't want to waste time with duplicate efforts)?
Are You Capturing Any Email On Your Website or Any Other Way?
Do You Use any Automation Sequences or Funnels For Marketing?
How Often Do You Send Emails?
Do You Spend Any Money on Social Media Marketing?
Check all Key Profiles That Exist
Google Business Profile
Apple Maps
Bing Places
Expertise
Facebook
Instagram
Twitter
LinkedIn Page
YouTube
Yelp
For Any Boxes You Checked Above, Please Provide URL of Profile and Associated Login Info
What Social Networks Are You Most Active On?
For Social Media Management Do You Use an Agency or Internal Team?
If You Have Any Videos You Would Like to Showcase, Please List the URL(S) Below. If URL(S) Not Available, Please Tell Us How to Access.
Please Upload Your Practice Logo
Please Upload Your Practice Logo
Upload any Images You Have of Your Practice (Staff, Equipment, Office, Exterior, Etc)
Upload any Images You Have of Your Practice (Staff, Equipment, Office, Exterior, Etc)
Anything Else You Would Like to Clarify or Share With Us?
SUBMIT