Practice Name
Dentist’s (owner) Name
Practice Address
Practice City
Practice State
Practice ZIP Code
Practice Office Phone
Practice Office Fax
Practice Cell Phone
Practice Other Phone
Preferred Number to Call
Office
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Owner email:
(we use this to email your First Impression plan)
Practice website domain:
How did you hear about
All About You Let’s discover a bit about what we might say in your First Impression Video script.
(The following is a list of marketable attributes. Indicate all that apply to you – whether they are presented on your current website or not.)
Sedation Dentistry
Additional Amenities
Do you have a special employee that your patients rave about? Perhaps it is the person in the front office, or a particularly caring dental assistant or hygienist?
Do you have any patients who might be considered celebrities? For example, the mayor, a pastor, the police chief, the rotary president, the neighborhood association president, or any media person such as TV anchors, reporters, sports figures, actors, musicians, etc.
Have you ever been interviewed or quoted by the media - ANY media now matter how small - TV, radio, or newspaper?
Have you ever been published in either the dental or lay media?
Have you ever presented a seminar to dentists or been involved in instructing or teaching other dentists in ANY capacity?
Have you ever given lectures to dental groups, seminars, schools, senior citizen groups or any civic organizations?
Have you ever participated in clinical trials for new toothpaste, consumer dental products or in-office dental equipment or supplies?
Why do you think a prospective new patient should choose you over the dozens of other dentists they could choose?
Please note any awards you've received and any aspects of community involvement such as volunteer work you've done, or charities in which you've been involved.
Please list any post graduate education or extended CE that you've taken
Do you consider yourself to be a Family Practice?
Do you consider yourself to be a Dental Boutique?
Do you treat children or do you refer to a pedodontist? (Do you have an age cut-off, e.g., kids under 5 go to the pedo, over 5 we accept)?
Do you have an associate or partner? (if so, please tell us how many associates or partners you have working there)
What are your office days and hours?
