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    First and Last Name (required)

    Name of Practice (required)

    Current Website URL

    Email Address (required)

    Phone (required)

    What is your practice specialty?

    What would be the top ten key words you would like to have users search for and find you online?

    Do you currently have content on your website for this focus?

    What are your intended goals to make your marketing program successful?
    Bring in more patientsCreate eventsPromote seminarsPatients find me on GooglePatients find me on FacebookKnown as an expert physician in my areaPress releases

    Are you currently doing Social Media?

    Do you have an ongoing SEO program in effect?

    Are you doing seminars?

    What are the challenges or difficulties you have experienced in your local market?

    How did you find us?

    Any questions or comments?