Content Marketing Application 1 | Digitalis Medical

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Order Number

Do you own or manage marketing for a healthcare facility?

Yes

No

What is the name of your facility? *

What types of patients do you care for? *

What type of conditions do you treat? *

What was your revenue for the last 12 months? *

What is your revenue goal for the next 12 months? *

What is the biggest obstacle keeping you from hitting your revenue goal? *

On a scale of 1-10, how important is it for you to achieve your revenue goal?

5

Current marketing efforts (please include all): *

Who are your top local competitors? *

What makes your practice unique? *

What services are the most profitable for your facility? *

Your first name: *

Work email: *

Best phone number *

Website address

If your application is approved, are you committed to showing up to the call on time? *

Yes

No

If the two of us mutually agree that we are the next best move for your practice, are you prepared to make an initial $1800 deposit on the call without issue or delay? *

Yes, I am committed to growing my practice.

No, even if I wanted to join, I wouldn't be able to do it.

I verify that this information is true and correct. *

Yes, I have answered everything truthfully.

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