Full Name *

Website *

Phone

Email *

Practice name *

Are you currently running ads? *

Meta

Google

Both

Not running ads

City and state *

How long have they run? *

Under 3 months

3 to 12 months

Over a year

Who runs them? *

An agency

In-house staff

I run them myself

what bugs you about the agency? *

We never see the dashboard

Slow replies

Lead quality is poor

No straight answer on results

Nothing, they are solid

Monthly ad spend? *

Under $2k

$2k to $5k

$5k to $10k

$10k to $25k

Over $25k

How do new patients find you today? *

Referrals

Instagram

Google search

Walk-ins and reputation

Have you tried paid ads before? *

Yes, got burned

Yes, results were unclear

Never tried

Because you tried before: what went wrong? *

Bad-quality leads

Booked but did not show

The Agency

Where do new patient inquiries arrive? *

Website form

Phone calls

IG / FB DMs

WhatsApp / SMS

Several of these

Who answers them, and how fast? *

Under 15 minutes

Within the hour

Same day

Next day or later

Honestly not sure

Because that claim is slow: who owns follow-up today? *

Front desk

Office manager

No one really owns it

Your CRM or practice-management system? *

PatientNow

Nextech

Symplast

HighLevel

HubSpot

Salesforce

Something else

No CRM

"Because you named a CRM: does it auto-respond to a new inquiry? *

Yes, within minutes

No

Not Sure

Consults per month? *

Under 10

10 to 20

20 to 40

Over 40

Average case value? *

Under $3k

$3k to $6k

$6k to $10k

Over $10k

Booking happens via? *

Calendar link

Front desk calls back

DM back-and-forth

Which of these do you know off-hand? *

Cost per booked-and-shown consult

Show-rate

Cost per lead

Consult-to-surgery rate

Which of these do you recognize? *

Spend is real, the calendar is not full

Leads book consults but do not show

Inquiries sit unanswered for hours

Price-shoppers instead of surgical cases

No idea which spend converts and which burns

A past agency hid the dashboard from us

Referrals carry us, ads never reliably worked

Old inquiries never get a second touch

Because no-shows made your list: roughly what share?" *

Under 20%

20 to 40%

Half or more

We do not track it

Because tracking doubt made your list: is a pixel installed? *

Yes

No

Not-Sure

Your biggest frustration in one line *