Marketing Needs Assessment Name First Last Practice NamePhoneEmail What is the primary purpose of marketing the practice?What are your practice goals? (example: increase production, more new patients)Describe your ideal patient in the box below.I place a higher value on (select one)Quantity of patientsQuality of patientsHow many new patients do you average each month?How many new patients do you want each month?What is your average monthly production goal?How much do you produce each month?What percentage of your production do you collect?What is your number 1 referral source of new patients? (If you do not know, you can run a referral report/s from your practice management software.)What percentage of new patients come from existing patients?Check the box next to all marketing you've done. Website Search Engine Marketing Content Marketing Social Media Marketing Internal Marketing (services or product) Direct Mail Newspaper Ad Magazine Ad Online Ad Phone Directory Community Events Blog Television Radio Busines to Business Referral Campaign Email Marketing Other**if other selected above please specifyDoes your logo represent your practice? Rank on scale of 0-5. 0-no, 5 yes very much.012345N/A I don't have a logoDo you have a website?YesNoAre you happy with your website?YesNoOn a scale of 1-5 (1-not active, 5-very active) how active are you on social media?12345What did you invest in the past 12 months on marketing?What do you have budgeted for your marketing for the next 12-months? (If unsure how to determine budget, we recommend 4-6% of the previous years collections)Please Upload Any Ongoing Marketing Agreements You Have.This will help us to evaluate the value you are receiving for the work being done.What resources do you need to help you reach your ideal marketing strategy?What type of dentistry interests you most? Select one.General/FamilyCosmeticRestorativeDental ImplantsPeriodontal SurgeryOral SurgeryPediatricOrthodonticsOther**if other selected above please specifyPlease list any particular treatments or services you wish to market and promote within your practice.Anything else you want us to know? Please type below. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.