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Marketing your practice can be an exciting part of fulfilling your practice goals. At practicemarketer.com we have experts who have helped thousands of professionals market their practices.

In order for us to provide you with a FREE Marketing Assesment and Growth Plan, we need to ask you a few simple questions regarding your practice. If you'd prefer to call us and speak directly with a marketing director, simply call 800-810-0553 ext 510

What is your current practice situation?

	I just bought my practice
	I just started a new practice
	I have a growing practice which I would like to build
	I am adding an associate and I need to build to support him/her.
	I would like to build my practice so that I can work fewer hours.
	I plan to retire within the next 5 years and I need to build my practice to sell it.
	I am happy with my practice, and I want to keep my patient flow steady.

Who are you?

	Solo Practitioner
	Partner in a practice with one partner or associate
	Member of a group practice with two or more partners or associates
	Other: (please explain):

How much would you like to increase your practice over the next 2 years?

	Over 100%
	50% to 100%
	25% to 50%
	25% or less

Do you have a practice marketing plan?

	Yes
	No

What type of marketing do you have in place? (choose as many as are applicable)

	Internal: to current patients (promotional posters, newsletters, ask for referal)
	External: to prospects (advertising)
	Professional: to other professionals (referral relationships)
	None

How would you rate your marketing?

	Very good : I'm reaching my goals.
	Somewhat effective: My marketing is inconsistent as are the results.
	Not effective: I am not getting the results I want
	NA: I do not market.

What External marketing or advertising are you involved in?

	Yellow Pages
	Signage
	Newspaper Ads
	Magazine Ads
	Billboards
	Coupons
	Direct Mail
	Website
	TV Ads
	Radio Ads

What Internal marketing are you doing?

	Asking for referrals
	Office signage, posters
	Patient recall
	Patient reactivation
	Patient newletters
	Patient email marketing

Do you track your marketing?

	Yes: I have an ongoing tracking system.
	Sometimes: We try to get everyone, but sometimes we miss
	Never: We don't know how or we don't have time.

How many practitioners within your specialty are in your area. (within 5-10 miles)

	Less than 10
	Between 10-25
	Between 25-50
	More than 50

Do your competitors advertise their practices?

	Yes
	Not Sure
	No

When was the last time you conducted a survey of fees in your market?

	Within the past year
	More than a year ago
	Never

How has your practice grown over the past 24 months?

	Up 25% or more ahead of prior year.
	Up 10% ahead of prior year.
	No significant change from year to year.
	Down by about 10% from previous year.
	Down by 25% or more from previous year.

Please provide the following information.

*Your Name

Profession

Specialty (if any)

Practice Name

*Address

*City

*State

*Zip

*E-mail

*Phone

Fax

Best time to call

Best number to call

How did you hear about PracticeMarketer.com?

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