MegaGen Practice
Catalyst Program
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Doctor's Name
*
First
Last
Legal Practice Name i.e. LLC, PLLC, Inc.
*
Doctor's Email
*
Doctor's Cell
*
Office Phone
*
Practice Address
*
Address Line 1
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Your address is needed to analyze detailed demographics in your market. Much of our success is based on knowing the key demographic factors to success. If it isn't a good fit we're happy to part as friends!
Specialty
*
Select One
General Dentist
Implantologist
Oral Surgeon
Periodontist
Prosthodontist
Gross Practice Revenue
*
Select One
150,000 - 300,000
301,000 - 500,000
501,000 - 1,000,000
1,000,001 - 2,000,000
2,000,001 - 4,000,000
4,000,001 - 5,000,000
5,000,001 or more
Please list the top three greatest obstacles you’d like to overcome?
*
It can be anything
What is the most effective and least effective marketing campaigns you’ve had?
*
If you have not done any marketing please answer NA
Do you currently advertise your practice?
*
Select One
YES
NO
I did but stopped advertising
What is your monthly advertising budget?
*
Select One
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
$11,000
$12,000
$13,000
$14,000
$15,000
$16,000
$17,000
$18,000
$19,000
$20,000 or more
Do you have someone managing your SEO?
*
Select One
YES
NO
How do you currently handle your inbound after hours calls?
*
Select One
Dedicated employee
3rd party call center
Calls go to voicemail
Select the % of growth positive or negative that you had last year
*
Select One
+1%
-1%
+2%
-2%
+3%
-3%
+4%
-4%
+5%
-5%
+6%
-6%
+7%
-7%
+8%
-8%
+9%
-9%
+10%
-10%
+11%
-11%
+12%
-12%
+13%
-13%
+14%
-14%
+15%
-15%
+16%
-16%
+17%
-17%
+18%
-18%
+19%
-19%
+20% or more
-20% or more
What is your case acceptance rate for dental implants?
*
Select One
I don't track case acceptance
+5%
+6%
+7%
+8%
+9%
+10%
+11%
+12%
+13%
+14%
+15%
+16%
+17%
+18%
+19%
+20%
+21%
+22%
+23%
+24%
+25%
+26%
+27%
+28%
+29%
+30%
+31%
+32%
+33%
+34%
+35%
+36%
+37%
+38%
+39%
+40% or more
Do you keep a list of patients who didn’t accept treatment?
*
Yes
No
Who manages your lead nurturing?
*
Select One
We don't have a lead nurturing program
I have a dedicated internal marketing person doing it.
I have a 3rd party provider doing lead nurturing for us
My CRM automatically does nurturing
Do you track and record inbound calls?
*
Yes
No
How many 1 & 2-star Google reviews do you have?
*
Select One
I don't have any google reviews
1
2
3
4
5
6
7
8
9
10
11 to 15
16 to 20
21 to 25
26 to 30
31 to 35
36 or more
Do you offer team incentives for growth?
*
Yes
No
Thinking about it
Do you track patient referral sources (e.g., google, facbook, tv etc.?
*
Yes
No
Thinking about it
Do you have an online scheduling on your website?
*
Yes
No
Thinking about it
Are you happy with your current website
*
Yes
No
Thinking of changing
Do you have video testimonials on your website?
*
Yes
No
Thinking of adding videos
Do you have a Google+ or Google Business page? (copy)
*
Yes
No
Not sure
Are you running a social media campaign?
*
Yes
No
No, but I am interested
Would you like to add $30K to $90K per month in incremental revenue?
*
Yes
No
Maybe would like to learn more
Do you both place and restore implants yourself?
*
Yes
No
How many years have you been placing implants?
*
Select One
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20 or more
Types of implants you place?
*
MegaGen
Nobel
Straumann
Neodent
Implant Direct
Biohorizon
Astra
SIN
Zimmer
Do you need any additional equipment or training to offer IV sedation?
*
Yes
No
If you answered no to having a CBCT do you have room for one?
*
Yes
No
Already have a CBCT
If you already have a CBCT please tell us the brand, model and age of the system. If you don't have a CBCT answer NA
*
How many dental chairs do you have?
*
Select One
1
2
3
4
5
6
7
8
9
10
11
12
14
14
15 or more
Is your dental license current?
*
Select One
Yes
No
Who does your advertising?
*
Select One
Internal team
External team
I do it myself
What specifically are you trying to promote?
*
i.e. implants, full-arch cases, Invisalign, teeth whitening etc.
How do you currently handle your inbound calls during office hours?
*
Select One
Front desk answers calls
Dedicated employee
3rd party call center
How did your practice perform last year?
*
Select One
We were down
We were flat
We were up
What is your growth goal this year?
*
Select One
+1%
+2%
+3%
+4%
+5%
+6%
+7%
+8%
+9%
+10%
+11%
+12%
+13%
+14%
+15%
+16%
+17%
+18%
+19%
+20% or more
What is your case acceptance rate for full-arch cases?
*
Select One
I don't track case acceptance
+5%
+6%
+7%
+8%
+9%
+10%
+11%
+12%
+13%
+14%
+15%
+16%
+17%
+18%
+19%
+20%
+21%
+22%
+23%
+24%
+25%
+26%
+27%
+28%
+29%
+30%
+31%
+32%
+33%
+34%
+35%
+36%
+37%
+38%
+39%
+40% or more
Do you have a lead nurturing program?
*
Yes
No
Not sure
What is the name and version of your practice management software?
*
Select One
Dentrix
Eaglesoft
Open Dental
Carestream Dental
SoftDent
PracticeWorks
Curve Dental
DentiMax
Ortho2
Fuse by Patterson
Ace Dental
Other
We continually update our integration capabilities to support newer or emerging systems. If you have a specific PMS that isn’t listed, we can explore custom integrations or provide guidance on compatibility.
How many 5-star Google reviews do you have?
*
Select One
I don't have any google reviews
1 to 5
6 to 10
11 to 15
16 to 20
21 to 25
26 to 30
31 to 35
36 to 40
41 to 45
46 to 50
51 to 100
101 to 150
151 to 200
201 to 250
251 to 300
301 to 350
351 to 400
401 to 450
451 to 500
501 or more
Are your local directories accurate (Google, Yelp, etc.)?
*
Yes
No
Not sure
Have you provided communication or telephone training to your team?
*
Yes
No
Thinking about it
Do you have an online chat bot on your website?
*
Yes
No
Thinking about it
Is your website mobile-ready?
*
Yes
No
Not sure
Do you have a Google+ or Google Business page?
*
Yes
No
Not sure
Do you have a patient appointment reminder service?
*
Yes
No
No, but I am interested
Would you be interested in a secret shopper and call training program?
*
Yes
No
Maybe would like to learn more
Would you like to improve your website conversion rates?
*
Yes
No
Maybe would like to learn more
Number of implants you place annually?
*
Select One
1 to 25
26 to 50
51 to 100
101 to 150
151 to 200
201 to 300
301 or more
How many years have you been restoring implants?
*
Click on the Dropdown
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20 or more
Check each of the procedures you offer
*
Dentures
Overdentures
All-On-X
Is your practice equipped to offer IV sedation?
*
Yes
No
Do you have an onsite working CBCT?
*
Yes
No
If you answered yes to having room for a CBCT would you be willing to invest in one to participate in the Renew Affiliate program
*
Yes
No
Maybe need to know more
Already have a CBCT
Approximately how many square feet is your practice?
*
How many surgical suites do you have?
*
Select One
1
2
3
4
5
6
7
8
9
10
11
12
14
14
15 or more
How many locations do you have?
*
Select One
1
2
3
4
5
6
7
8
9
10
11
12
14
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50 or more
Is your dental license being challenged or under review?
*
Select One
No
Yes
Please upload the following 6 photos: 1. the front of your building 2. Your Parking Lot 3. Waiting Room 4. The Consult Room 5. Your Surgical Suite 6. Your CBCT if you have one.
*
Click or drag files to this area to upload.
You can upload up to 100 files.
We are doing our best to build a strong brand with first class dental practices. Please let us see where we will be sending Renew patients.
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