OB Dev3 1 Welcome Onboard!2 About Your Practice3 About Your Marketing4 About Your Website5 About Your Services6 Confirmation of Submission Welcome To DentalMarketing.com Please fill out this onboarding form as accurately as possible. This form will provide us with the information we need to build your website and launch your marketing campaigns. Complete one form for each of your locations. Basic InformationPractice Name*Opening Date* MM DD YYYY Practice Phone Number*Practice Address* Street Address Suite Number City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Did this practice have a previous name or address?YesNoPlease provide the previous name and/or address.*Nearby Landmark(s)(e.g. Across the street from Macy's)Payment and InsuranceWhich methods of payments do you accept?(e.g. Cash, Personal Check, CareCredit, Credit Cards, In House Plans)Do you accept Insurance?YesNoList the plans and specify in-network plans, starting with the top five:Staff and ProvidersWould you like to assign a marketing point of contact for your practice?YesNo, I (the doctor) will be the point of contactPoint of Contact Name*Point of Contact Phone Number*Point of Contact Email*How Many providers does your practice have?12345More than 5Are any of your providers board-certified?*All of our providers are board certifiedSome of our providers are board certifiedNone of our providers are board certifiedPlease list the providers that are board certified.*Are any of your providers an AGD Fellow?*YesNoPlease list the providers that were recognized as an AGD Fellow.Do you have any affiliations, awards or achievements that should be highlighted in the marketing? If so, please list them below with any related links.Do you or any other doctors practice in other offices?*YesNoPlease provide the names of the other practices*Would you like to feature or highlight a specific provider on your website?YesNoPlease provide the provider's nameFun Facts and Additional InformationPick 3 of the fun facts below for each doctor How many/what kind of pets do you have? Favorite kind of music? Favorite food? Favorite sports team? Do you have an unusual talent? Favorite movie? Doctor*Doctor1-nameDoctor 1 - Fun Facts*Doctor 1 - Fun FactsDoctor 2 - Name*Doctor 2*Doctor 2 - Fun FactsDoctor 3 - Name*Doctor 3 - Fun Facts*Doctor 4 - Name*Doctor 4 - Fun Facts*Doctor 5 - Name*Doctor 5 - Fun Facts*Business Hours*Additional Business Hours Notes(e.g. lunch breaks, alternate schedules) General Marketing StrategyDo you know the first-year value of a new patient at your practice?*YesNoWhat is your first-year value of a new patient?*Please enter a number greater than or equal to 1.Would you like help running an analysis?*Simply run a report for the total production by new patients in their first year for the last two years and divide by the number of patients. (For example: $175,000/70 new patients = $2,500) *We want to make sure to only include patients who have been around for a full year, otherwise the value will be artificially low. So we want to pull ALL new patients from 24 months ago - 12 months ago.YesNo - I can pull this data myselfWhat factors do you believe lead patients to choose your practice?(Provide a brief explanation)Which cities, neighborhoods, or towns are most of your patients coming from?(List the areas)Are there any specific locations from where you do not wish to attract patients?*(List the areas) e.g., too much competition, differing demographicList the top three dental services you want to focus on for marketing your practice.*(e.g., Dental Implants, Invisalign, Emergency Care) Are you currently engaged with another marketing company?*YesNoPlease specify your point of contact, email and phone number.Point of contactEmailPhone NumberHave you already submitted a cancellation request with the previous agency?YesNoHave you conducted any direct mail campaigns in the last 90 days?YesNoPlease provide more detailsWhat are the three main messages or focus areas for positioning your practice?(e.g., convenience, financing options, latest technology)What unique amenities or services do you offer in your office?* Family Scheduling Financing Options Beverage Bar Children's Play Area Extended Hours Video Games Netflix Wireless Headphones Spa Services Blankets and Pillows Massage Chairs Flat Screen TVs in Patient Rooms Music Saturday Appointments Warm, Scented towels Free Parking Multilingual Special Needs Dentistry Geriatric Dentistry - Senior Care List them below by adding a new line for each additional amenity.List Them Do you accommodate same-day emergency appointments?YesNoPlease provide details.What current marketing or advertising initiatives are you involved in?(List them including any related websites)Marketing InitiativeWebsite Practice IncentivesChoose up to three special offers to attract new patients to your practice. These offers are designed to serve as incentives for new patient acquisition. Discounted Adult Complete Checkup: Only $___ Special Rate for Emergency Exam: Only $___ Children's Complete Checkup at $___ $___ off Orthodontic Treatment Complimentary Cosmetic Dentistry Consultation Complimentary Dental Implant Consultation Please provide details related to this special (e.g. price, description, restrictions, and ADA codesBranding and DesignIs there an existing logo for your practice?YesNoAdd Logo HereAccepted file types: ai, png, jpg, eps.Are you happy with your logo/branding?YesNoDoes your office have a theme?*YesNoPlease explain your office theme.*Do you have a tagline or slogan that could be used as part of the logo?*YesNoTagline / Slogan*Is there a unique story behind your practice?*YesNoTell us your story*Are there any inspiring visuals associated with your practice?*YesNoList your inspiring visuals*What words do you want your patients to associate with your practice?*Generally, what logos or brands do you like and why?*Upload any inspiration to provide to our designers Drop files here or Accepted file types: jpg, gif, png, jpeg, pdf, doc, docx. Would you like a tooth as part of your logo?*YesNoAny further info you’d like to add regarding your logo / brand? Color Palettes Choose up to 3 color palettes to explore* Pastels Jewels Neutrals Primary Earth Pinks Reds Oranges Yellows Greens Teals Blues Purples Grays Browns Typeface Choose a typeface*Sans SerifSerifScriptHand Type Brandmark Choose a type of brandmark*SymbolicPictorialLetterformWordmarkEmblemDo you have Stationary for your office (business cards, letter heads, envelopes)?YesNo, I am interested in your help creating this.Does your office have any branded video content or patient testimonial videos?YesNo, I am interested in your help creating this.Social Media PresenceWhat is your company's Instagram username?(Provide Username)What is your company's Tiktok username?(Provide Username)What is your company's Facebook page URL?(Provide URL)Access to Marketing PlatformsDo you have a Google Ads account?YesNoI'm Not SureWhat is your Google Ad ID?Please specifyDo you have a Google Tag Manager account?YesNoI'm Not SureWhat is your GTM ID?Please specifyDo you have access to Google Analytics, Google my Business, Search Console, or any other Google Products?YesNoI'm Not SureWhat is the Gmail associated with your Google My Business Page (Google Maps Listing)?(Provide the Gmail Address) Do you have a Facebook Business ID?YesNoI'm Not Sure(Your Facebook Business Manager ID is a unique 15-digit identifier linked to your facebook Business Manager account.)Do you have a Bing Ads account?YesNoI'm Not SurePlease provide your Bing Ads IDWould you like to know more about running paid ads on Microsoft Bing? Special Offer: If you don't currently have a Bing Ads account, we highly recommend our Bing ads program, especially if your practice services an older demographic. It's an additional $299/month, discounted from the regular $499/month for newly onboarded members. This discount is only available during the onboarding process.YesNo Basic InformationDo you currently have a website?*YesNoWebsite Domain (i.e. http://www.yourdomain.com) Do you own the content on your existing site?YesNo (we will not create duplicate content pages; if you have over 20 pages we will need to discuss action plan.)What do you like about your current website?Is there anything you DO NOT want moved from your current website? Let us know what you don't want moved from your existing site.(Optional: Add screenshots of what you don't want added) Drop files here or Domain and HostingDo you have more than one Domain/Website?YesNoList any domains name you've purchased or that you would like to buy. Did you purchase your domain through GoDaddy?YesNoI Don't knowGoDaddy Account NumberGoDaddy Username or Registrar UsernameRegistrar Login URL: (i.e. domains.google, enom.com, godaddy.com, hover.com, namecheap.com, networksolutions.com, register.com)Registrar PasswordEmail and NotificationsEmail addresses for appointment requests: (Where should notifications be sent when someone requests an appointment?)* Are your email addresses linked to your website (e.g., name@yourpractice.com)?YesNoWho is hosting your email?Would you like us to create @yourpractice.com emails for an additional cost? A one time setup fee of $97 and $8 / user / month.Yes, Please create emails for my practice.NoScheduling and AppointmentsDo You use an online scheduler for booking appointments?*YesNoI'm not surePlease specify the service (e.g., ZocDoc, LocalMed, DemandForce)Please specify 😱 Did you know that online booking, which lets patients schedule appointments in your Practice Management System (PMS) 24/7, can increase conversion rates by a staggering 193%? Select our preferred vendor to receive discounted pricing. We'll connect you with them and guarantee your marketing and PMS are properly connected.NexHealth ($299/mo)*Integrates with: Cloud9, Curve, Denticon, Dentrix, Dentrix Ascend, Dentrix Enterprise, Eaglesoft, OpenDental, Practiceworks, OrthoTrac. Dolphin, eCW, Athena.Yes, I would like online booking.No, maybe later. General DentistryWhat does your regular checkup include? Professional Cleaning Full Examination Digital X-rays Traditional X-rays Oral Cancer Screening DiagnoDent Other Please specifyGeneral Dentistry Services Amalgam Fillings Composite Fillings Oral Cancer Screening Sleep apnea - Oral Appliances Sealants Halitosis Treatment Mouth Guards - Children Mouth Guards - Adults Night Guards Inlays and Onlays Fluoride - Gel Fluoride - Foam Fluoride - Varnish Impressions - Traditional Impressions - 3-D/DIgital Root Canal Treatment TMJ - Oral Appliances Other Please SpecifyCosmetic DentistryTeeth Whitening DaVinci KoR Zoom! Opalescence LumiBrite Pola GLO Science In-house whitening product Other Please specifyVeneers Traditional No-Prep Veneers Porcelain Composite Lumineers ProVeneer DuraThin DaVinci Veneers MAC Veneers EMAX Empress Other Please SpecifyCrowns & Bridges CEREC/one visit Traditional/2+ visits Porcelain Other Material Please specifyPeriodonticsPeriodontics Scaling and Root Planing Gum Graft Surgery Dental Crown Lengthening Gingivectomy Root Surface Debridement Laser Treatment Pocket Reduction Osseous Surgery Ridge Augmentation Ridge Preservation Regenerative Procedures Pinhole Gum Rejuvenation Sinus Lift Other Please specifyDentures & Dental ImplantsDentures & Dental Implants Subperiosteal Implants Endosteal Implants All-on-4 Implants Teeth-in-a-Day Fixed Dentures Denture Stabilization Traditional Dentures Other Please specifyOrthodonticsOrthodontics Traditional Braces Ceramic Braces Lingual Braces Damon Smile Invisalign ClearCorrect Six Month Smiles FastBraces Retainers In-house Clear Aligners Other Please specifyPediatric DentistryPediatric Dentistry Services Sealants Fluoride Applications Fillings Crowns Emergency Dentistry Phase 1 Ortho. Other Please specifyPediatric Services - Age RangeInfantsToddlersTeensSchool-ageOral SurgeryOral Surgery Bone Grafting Wisdom Teeth Extractions Extractions TMJ Surgery Cavitation Surgery Other Please SpecifyAnesthesia/SedationAnesthesia/Sedation Local Anesthesia Oral Sedation IV Sedation General Anesthesia Laughing Gas NuCalm Other Please specifyTechnology / SystemsTechnology / Systems DIAGNOdent The Wand SOLEA CEREC Intraoral Camera WaterLase CBCT VELscope iTero Botox Juvederm DEXIS CariVu DEXIS DEXcam Hiossen Implants LANAP Galileos 3D Imaging CAD/CAM System Other Please specifyHolistic or "Green" DentistryHolistic or "Green" Dentistry Silver Filling Removal Laser Bacterial Removal Healing Tooth Decay Safe Amalgam Removal Metal-Free Implants Metal-Free Fillings Mercury Removal Other Please specifyOtherOther Services Confirmation of SubmissionSubmitter DetailsName* First Last Email Address*Note: A duplicate of this completed form will be sent to the provided email for your records Verification of Information* I hereby verify that all the information provided above is accurate and without errors.
