Practice Name *

Full Name *

Email *

Do you want to cancel the foundation software? *

Yes

Not Sure

What are the main reasons you wish to stop the leads and enquiries? *

What could Dental Marketing Australia have done better? *

Did you expect more enquiries? *

Did you expect a higher level of quality for the enquiries? *

Were you satisfied with the level of communication and service provided? *

What expectations did you have that were not met? *

Was the cost too high for your practice? *

What price would make sense for your practice? *

If we can accommodate that price, would you like to continue? *

We're sorry you wish to stop receiving leads and enquiries. Is there anything we can do to change your mind?

Do you have any further feedback that could assist us?

As per your Services Agreement, by submitting this form you acknowledge the following:

- 30 days notice must be provided to cancel your contract. Your campaigns must be turned on and running during these 30 days.

- If you are cancelling without a 30 days notice or before contract period is up, you will need to pay out the remaining days at a rate of $70 per day.

- All monies owed to DMA will be due immediately and will be automatically charged to your payment method on file.

- A $250 re-activation fee will apply if the campaigns are re-activated in the future.

- On the "effective date" of cancellation, we will begin to deactivate your account: pause all campaigns, release all tracking numbers, un-publish all landing pages and your data will be removed from the reporting dashboard. Please make sure you download any reports you require prior to the effective date.

Cancellation Terms *

I understand and agree

Effective Date:

This is when your campaigns will be stopped. All cancellation requests require 30 days notice, unless you wish to pay out the remainder of your contract term instead.

Effective Cancelation Date *