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Conference
Account Manager
*
-Select Account Manager-
Jack
Jesse
Mike
Troy
Other
Account Manager Details
Client Vertical
*
-Select Client Vertical-
Dentistry
Optometry
Physical Therapy
Sleep Medicine
Veterinary
Home Services
Other
Vertical Details
Service Level
*
-Select Service Level-
Deluxe
Social
Professional
Elite
Premium
Executive
Service Level Details
Monthly Charge
*
Status
*
Needs First Draft
Client Name
*
First
Last
Client Cell Phone
Email
*
Which Google Account Do You Want Added to the Analytics Reports?
*
Business Name
*
Business Email
*
Business Telephone
*
Have you ever used Call Tracking for your business?
*
Yes
No
Unsure
Are you currently using Call Tracking?
*
Yes
No
Unsure
Business Address
*
Business Hours
*
Business Founding Date
Example: January 1998
Business Payment Options
Select All
Cash
Personal Check
Traveler's Checks
Invoice
Financing Available
Insurance
PayPal
American Express
Visa
Mastercard
Discover
ATM / Debit
How many locations does the business have?
*
1
2
3
4
4+
Second Business Address
Second Phone
Second Business Email
Second Business Hours
Third Business Address
Third Phone
Third Business Email
Third Business Hours
Fourth Business Address
Fourth Phone
Fourth Business Email
Fourth Business Hours
Website Domain
*
Domain Based Emails
Domain Information
How Many Google My Business Listings Does Your Business Have
--Please Select--
None, Please Create
1
2
3
4
5
6
How many GMB Listings Need to be Created?
GMB Listing #1 Link
GMB Listing #2 Link
GMB Listing #3 Link
GMB Listing #4 Link
GMB Listing #5 Link
GMB Listing #6 Link
Facebook Page Link
Facebook Post Types
Instagram Page Link
Blog Post Ideas
Which website theme do you want to build your website after?
*
--
Theme 1
Theme 1 multi
Theme 2
Theme 2 multi
Theme 3
Theme 3 Stats
Website Primary Colors
*
Types of Images to be Used
*
How would you like your website content handled?
--
Use the content on my current website
Please provide content (Professional level and above)
I'll provide my own
Other
Additional Notes (Optional)
Services Offered
Does your practice provide emergency services?
*
Yes
No
I don't know
Are your emergency services 24/7?
Yes
No
I don't know
Top 3 services to promote
Testimonials (Limit 5)
Tagline(s) to feature on the Homepage
Do you have any of the following 3rd Party services?
Online Bill Pay
Live Chat
Digital Forms
Patient Scheduling Software
Domain Based Emails
Video Library
Online Bill Pay Service Provider
Live Chat Service Provider
Digital Forms Service Provider
Patient Scheduling Software Service Provider
Domain Based Email Service Provider
Video Library Service Provider
Submit additional files to be included (Content, Photos, Logos, etc.)
Drop files here or
Select files
Max. file size: 256 MB, Max. files: 4.
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