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Marketing Questionnaire

Please check any of the following that apply to your practice.

Practice Name
Name
E-mail Address
Address
City
Zip Code
State/Province
Country
Phone
-
Fax
-

1. I want to attract new patients to my practice.
2. I would like to reactivate many of my patients who have "fallen through the cracks"
3. I would like a consistent way to communicate with both existing & prospective patients.
4. I have a new practice and we are just establishing ourselves.
5. I have a strong practice and I'm looking for steady growth
6. I want to aggressively grow patient base (more than 15 patients per month)
7. I'm satisfied with current patient base and want to maintain current status
8. I want to change the mix of the current patient base.
(If checked, explain below how you wish the base to change.)