Healthcare CRM Platinum Partner Application

Healthcare CRM Platinum Partner Application

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TELL US ABOUT YOU

First up, share a little about you and your business.

Practice location

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ABOUT YOUR PRACTICE

How would you describe your admin team?*

How many clinics do you own?

How many patients does (do) your clinic(s) have in total?

How many new patients does (do) your clinic(s) receive every week?

Which system(s) are you using to contact your patients?*

Which practice management software do you use?

Which is the quietest month of the year for your practice?

Which is the busiest month of the year for your practice?

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YOUR GOALS

Is there anything else you would like to add or any questions to ask?*
What are your top 3 goals in the next 6 months for your business?*
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PARTNERSHIP PREFERENCES

Programs you are interested in:*

Which Platinum Partner package would you like to sign up for?

Which edition of the Keap App would you prefer?

Why do you want to Partner with Siliceous Solutions?*

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ABOUT YOU

How would you describe yourself?*

What is your monthly budget for administrative tasks?

What percentage of your revenue do you think should be spent on administratiive tasks?

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ABOUT YOUR SERVICES

What type of services do you offer?*
What service generates the most revenue for you? (select one)*
How do you attract new patients?*
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WEBSITE AND SOCIAL MEDIA

Who built the website?*
What do you like most about the website?*
What do you dislike most about the website?*
Do you feel like your website represents your business effectively?*
Which social media platform(s) is your business active on?*

Which channels?


Which best describes the results from your social media efforts?*

How often do you post on your social media accounts?*


Do you run any paid ads, e.g. Google, Facebook, etc.?*

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Review & Sign

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