Growth4Dentists - Client Onboarding Intake Form

Practice Fundamentals

Let's start with the basics about your practice

Practice Name *

Practice Address *

Main Phone Number *

This is the number that will receive call tracking

Website URL *

Years in Business *

Practice Type *

Number of Locations *

Owner Information

How do we reach you?

Owner Name *

Owner Email *

Owner Cell Phone *

For text/Slack communication

Preferred Communication Method *

Text

Slack

Best Day/Time for Weekly 60-Min Calls *

Baseline Performance Metrics

Help us understand where you're starting from

Annual Revenue (Last 12 Months) *

Average Monthly New Patient Volume *

How many new patients do you get per month?

Average New Patient Value

First appointment production (if known)

Total Monthly Marketing Budget *

Current Google Ads Spend (Monthly)

Do You Know Your Current CAC (Customer Acquisition Cost)?

Yes

If Yes, What Is Your Current CAC?

Team Structure

Tell us about your team

Front Desk Team Member Names *

Number of Dentists (Including Owner) *

Number of Hygienists *

Number of Operatories (Chairs) *

Specialties Offered

Implants

Cosmetic Dentistry

Orthodontics

Endodontics

Emergency Dentistry

Current Marketing Infrastructure

What's already in place?

Website Platform *

Who Manages Your Website? *

Is Google Ads Currently Running? *

Yes

Is Your Google My Business Claimed? *

Yes

Current Google Review Star Rating

Do You Have Call Tracking? *

Yes

Web Developer Information

We'll need to coordinate with your developer for landing page work

Developer/Agency Name *

Developer Email *

Developer Phone *

Developer's Typical Response Time

How Is Developer Paid?

Goals & Pain Points

What do you want to achieve?

Primary Goal for Next 90 Days *

New Patient Goal (Per Month) *

How many new patients per month would make you happy?

Biggest Marketing Frustration Right Now *

What Have You Tried That Didn't Work?

Why Did You Hire Growth4Dentists? *

Patient Communication

For your monthly SMS/Email blast

Do You Have an Email Marketing Platform? *

Yes

If Yes, Which Platform?

Approximate Size of Patient Database

Practice Management System (PMS) *

Final Confirmations

Almost done!

Have You Informed Your Front Desk About Call Recording? *

Yes

Not Yet

Can You Review and Approve Deliverables Within 24-48 Hours? *

Yes

Landing page copy, ad campaigns, etc.

Will You Commit to Reinforcing Front Desk Training From the Top? *

Yes, Absolutely

I'll Try

Anything Else We Should Know?

✓

Thank You!

Your intake form has been submitted successfully. We'll review this information and reach out within 24 hours to schedule your kickoff call.

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