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Design Questionnaire (NR)

Practice Name(Required)
Is this the phone number you want us to forward our call tracking numbers to? If not, please provide the number we should use.

Physical Address

Billing Address

Consent

Mailing Address

We will be sending you sample packets of your postcards each month. Is your mailing address the same as the physical address?
If no, please provide your mailing address:

Primary Contact

Primary Contact Name
This should be the primary person that will be running point and provide approvals on the dental postcard campaigns.
Consent
Secondary Contact Name

Dental Team

Please provide for your team members that should have dashboard access and receive alerts.
Names and Titles of Dental Team (Dr, Hygienist, Assistants, Team Members)
Names and Titles of Dental Team (Dr, Hygienist, Assistants, Team Members)
Names and Titles of Dental Team (Dr, Hygienist, Assistants, Team Members)

About Your Practice

Select all that apply by holding "control" (Windows) / "command" (Mac) key while choosing.
*Most practices average between $2000-4000 based on how much specialty work they do in-house vs. referring out. Practices who do a lot of implants, cosmetics, invisalign, etc. are typically closer to $4000 or more, where practices who stick to mainly bread and butter dentistry tend to be closer to $2000.
If so, what are they?
% Insured, % FFS, % Medicaid, Financing Options, etc.
Income level? Family structure? Ethnicities?
We will recommend marketing messaging for your practice, as well as offers that should generate good results. However, if there are any specific messages or offers you’d like considered to be used on the card, please list them here. Based on the information you have provided, we will develop a card design that we believe will represent your practice and connect with the types of new patients your are targeting. If you like, you can check out our postcard gallery and choose a design you like as a starting point. If you choose to utilize the postcard gallery, please list here the number of your favorite design and any notes.
Do you have doctor, staff or office photos to be considered for your card?
These could be images of the doctor(s), family, team. office, etc. Please also include a high quality logo file. Make sure all images are hi-resolution, print quality.
Drop files here or
Max. file size: 256 MB.