Community Outreach Visit Log
Section 1: Visit Info
Visit Date
*
-
Month
-
Day
Year
Date
Section 2: Marketing Lead Info
DIRECTIONS: Write address only if needs to be updated in the marketing list. Add other info regardless.
Marketing Geographical Area
Southwest Chicagoland
St. Louis Metro
Metro East St. Louis
Name of Business
*
Use the same name as listed in Upper Route App/ Marketing lists for easy identification
City & State of Business (eg: Maryville, IL)
*
Section 3: Details of Interaction
Tasks Accomplished
*
Marketing material dropped in mailbox
Marketing material dropped on front desk - no communication with staff
Brief info provided to front office staff
Detailed pitch to front office staff
Met a Manager
Met a Provider
Scheduled a connection call with Dr. Bansal
Scheduled a MindWeal Deep Dive with Dr. Bansal
Topics Covered In the Info Provided/Pitch
*
Introduced MindWeal
Asked to Speak with the Key Decision Maker
Educated about MindWeal Platform
Educated about M-Wise
Educated about About Wellness Scores
Educated about ADHD Testing
Current updates provided (TriCare Out-of-network status)
Offer a Connection Call & MindWeal Deep Dive with Dr. Bansal (CEO Invitation)
Marketing Material Dropped
*
Business Cards
Brochures
MindWeal Pens
One-pagers (set of 3 one-pagers clipped together)
How many sets of one-pagers were dropped?
*
Remember: Drop off one set per provider, with a maximum of 10 sets total per lead
Total No. of providers
*
is correct on file
is incorrect, need to update
Updated Total No. of Providers
*
Questions asked or concerns raised by marketing lead about MindWeal:
Pain Points (In their Practice) Mentioned:
Section 4: Contact Info of Lead
Phone No. on file
*
couldn't confim
confirmed, is correct
confirmed, is incorrect
Updated Phone Number
*
Please enter a valid phone number.
Address on file
*
couldn't confim
confirmed, is correct
confirmed, is incorrect
Updated Address
*
Email on file
*
none on file, need to add
couldn't confim
confirmed, is correct
confirmed, is incorrect
Email
*
example@example.com
Fax No. on file
*
couldn't confim
they don't have a fax no.
confirmed, need to log
Fax Number
*
Please enter a valid phone number.
Section 5: Social Media Marketing
Exciting story about the Marketing Lead that can be shared on Social Media
Take Photo (Selfie Mode)
Take Photo (Regular Mode)
Take Photo (Regular Mode)
Take Photo (Regular Mode)
Section 6: Final Thoughts
Any Other Notes
Section 7: Form Submission
Date & Time Stamp at time of Submission
Submit
Should be Empty: