Preeminent Practice Ad Audit™

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atclid

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utm_source

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utm_medium

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utm_campaign

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utm_content

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utm_term

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What Type of Health/Medical Practice Do You Own* This field is required.

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What Is The Name of Your Practice* This field is required.

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What Is Your Website?* This field is required.

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Who Is Your Ideal Patient/Niche Patient?* This field is required.

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What Is Your Current Monthly Patient Volume and Revenue* This field is required.

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What Is Your Goal Monthly Patient Volume and Revenue* This field is required.

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What Do You Believe Is Stopping You From Hitting Your Goals* This field is required.

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Name* This field is required.

First Name

Last Name

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Email* This field is required.

example@example.com

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Phone Number* This field is required.(I may text you with further questions after you submit your application)

Please enter a valid phone number.

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I understand that in order for my application to be considered and approved, I must book a time to talk with Brad or his team on the next page. * This field is required.You will be redirected to the next page when you click “YES”

YESNO