What is your practice name?
*
What is your website URL?
*
What is your first name?
*
What is your position at the practice?
*
Owner
Associate
Practice Manager
Marketing Manager
Assistant
Other
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What is your practice type?
*
Plastic Surgery
Plastic Surgery + Medspa
Medical Spa
Refractive Surgery
Dermatology
Other
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Which EMR do you currently use?
*
ModMed
Nextech
Patient Now
Aesthetic Record
What are you using for a CRM, marketing automation platform, or lead tracker?
*
Spreadsheets
MyMedLeads
Constant Contact
NextechCRM
EZtexting
How many users would you expect to have using the software on a daily basis?
1
2
3
4
5
6
7
8
9
10+
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What is your last name?
*
How many locations do you see patients in?
*
1
2
3
4
5
6
7
8
9
10+
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Where are you located?
*
Are you interested in advertising?
*
Yes
No
Already Running Ads
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What is your email?
*
What is your cell phone number?
*
Would you like your practice secret shopped?
*
Yes
No
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