Ok, we’ll make this quick and painless. But before we start, we don’t want to be rude… So what’s your name?
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Awesome! What's your email
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What's your practice's name?
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Amazing! What is your practice's website address?
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So that we can customise your experience, which service contributes 80% of your production? (Good ol’ Pareto Principle)
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Cosmetic Dentistry
Dental Implants
Pediatric dentistry
Orthodontics
Which types of marketing do you currently use? (Select more than one if applicable)
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Facebook Ads
Google AdWords
SEO
Radio
TV
Direct Mail
Other
None
What is the #1 single biggest obstacle holding you back right now from reaching your growth goals? (This is the biggest thing we can help you with, so give as much detail as you can about WHAT it is you feel is holding you back)
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Where do YOU see the greatest opportunity to scale your practice in the next 3-12 months? (select all that apply)
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Building an awesome practice culture
Delivering a better patient experience
Attracting more high-qualified leads
Increasing Case Acceptance
Converting a higher percentage of current leads into patients
Decreasing patient churn
Getting more unscheduled treatment plans scheduled
All of the above
What is your current MONTHLY production?
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Under $100,000
$101,000 - $150,000
$151,000 - $200,000
$201,000 - $250,000
$251,000 - $300,000
$301,000+
What is your Target MONTHLY production Goal?
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$101,000 - $150,000
$151,000 - $200,000
$151,000 - $200,000
$251,000 - $300,000
$301,000 - $350,000
$351,000+
How many NEW High Value Cases (Ortho, Cosmetic, Implants or Ortho) are you currently averaging per MONTH?
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Under 10
11 – 20
21 – 30
Over 30
What’s your goal for NEW High Value Cases (Ortho, Cosmetic, Implants or Ortho) per MONTH?
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11 – 20
21 – 30
21 – 30
Over 40
Which best describes you?
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I have the financial resources to invest in my practice’s growth.
I have the ability to generate the financial resources to invest in my practice’s growth.
I have the ability to generate the financial resources to invest in my practice’s growth.
How much is your monthly marketing budget?
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Under $3k
$3k – $5k
$5k - $10k
$10k - $20k
$20k - $35k
$35k - $50k
$50k
How much is the average patient worth to you over their lifetime?
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Less than $10k
$10k – $20k
$20k - $30k
$30k - $40k
$40k - $35k
$35k +
Why is right now a good time for you to get involved with this program and scale your business?
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On a scale of 1 - 10 how interested are you in enrolling in the Practice Momentum Building Program?
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1
2
3
4
5
6
7
8
9
10
11 - lol
When are you looking to getting started?
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Immediately
In the next 2 weeks
2 - 4 weeks
4 - 6 weeks
6 weeks +
Never
Do you PROMISE that if you qualify for a call, you will show up at the selected time?
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Yes
No
Finally - why do you feel like you should be considered to be a part of our program? Why should we choose to work with you?
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Fantastic! It looks like we can DRAMATICALLY help you grow your practice using some of the latest ‘ahead-of-the-curve’ marketing strategies. What's the best phone to react you at?
Phone
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