Show Me What's Possible
This form should not take more than 7 minutes.
About Your Practice 🩺
Full Name
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What is the name of your practice?
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What type of practice do you run?
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Choose one or more options
How long have you been open?
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Are you a solo practitioner or do you have a team?
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Choose one or more options
How many treatment rooms do you have?
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What are your current clinic hours? e.g Mon-Fri 9am-5pm
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Do you accept insurance, cash pay, or both?
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Insurance only
Cash pay only
Both
Your Numbers 📈
Roughly how many new patients do you see per month right now?
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Choose one or more options
What's your average patient visit value?
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Choose one or more options
What would you consider a 'good month' in revenue? (ballpark is fine)
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Choose one or more options
Do you currently have a monthly marketing budget?
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No budget
Under $500/mo
$500–$1,500/mo
$1,500–$3,000/mo
$3,000+/mo
What is your #1 service or treatment, the one you want more patients for?
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Your Digital Presence 🤩
Do you have a website?
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Yes, it's great
Yes, but it needs work
Yes, but it's not live
No
Do you have a Google Business Profile (Google My Business) set up?
Choose one or more options
When someone searches for your specialty in your city, do you show up?
Yes
No
Not sure
If Yes, roughly where do you rank?
Choose one or more options
Do you have active social media pages?
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Yes
No
Please select all relevant platforms
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Facebook
Instagram
TikTok
LinkedIn
YouTube
Other
How often are you posting on social media? (please select 1)
Choose one or more options
Do you or have you run any paid ads?
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Yes
No
If Yes, please select all relevant platforms
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Choose one or more options
Are any of these paid ads active now?
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Yes
No
Not sure
Do you have an email list of current or past patients?
Yes and I email them regularly
Yes but I never use it
No
Do you actively collect patient reviews?
Yes
No
If Yes, please share which platforms you publish reviews on.
What You've Tried 🤔
Have you ever tried a marketing agency or consultant?
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Yes
No
If Yes, how was your experience?
What was the biggest challenge?
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Have you tried radio or TV advertising? (or other media)
Yes
No
Currently
If Yes, please select all media advertising you are using.
Choose one or more options
What's the #1 thing you've tried that felt like a complete waste of money?
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What's the one marketing thing that HAS worked, even a little?
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Goals & Pain Points 🎭
What's the #1 reason you're looking for marketing help right now?
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What does success look like for your practice 12 months from now?
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What's your biggest pain point with marketing your practice?
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How do / will you measure marketing success?
How confident are you in your current marketing?
Not Confident
Very Confident
What do you think is holding you back from growing faster?
Let's Make Sure We're a Fit 🦄
Are you the decision maker when it comes to marketing spend at your practice?
Yes, it's my call
I share the decision
No (someone else decides)
Are you ready to invest in done-for-you marketing in the next 30 days?
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Select an option
Are you happy for us to stay connected?
Yes sure!
No thanks.
How did you hear about PinkMarketing.Life?
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Choose one or more options
Is there anything else you'd like us to know before your call? (optional)