FREE MARKETING ANALYSIS    
Doctor’s name:
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Practice name:
Phone number:
Cell Phone:
Email:
Web Address:
Your Information:
Total number of new patients in the last 12 months:
Total number of referred new patients in the last 12 months:
Total number of active patients:
 Marketing:    
What marketing and/or advertising did you do over the last 12 months?  

What was the approximate cost of those actions?

 
What is your web address?    
Anything else you would like to say?  
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