Fill Out the Application Below to See if you Qualify For Our Partnership System that Gets Doctors Results Year After Year!

Before You Complete This Form

This form takes less than 10 minutes to complete but provides us with everything we need to know to see if you qualify for a long-term partnership. In return for answering these questions, we promise not to waste your time if we know you don’t qualify - does that work? *

We have helped hundreds of doctors like yourself get consistent patients. Many of them have worked with us for 5+ years. Because of this, we only choose to do business with good doctors who understand what teamwork and mutual respect are. We understand that you may have been burned by marketing companies in the past. We get it! But we are different. We respect you. We respect your time. And because of this, we only work with doctors who respect us, too, so we can work together as a team to achieve a win-win - does that work for you? *

Contact Information

Full Name *

Cell Phone For Call Reminders *

Best Email Address *

What is your practice's website? *

Tell Us About Your Practice

What is your role at the practice? *

Do you have a physical location? *

What is your current monthly revenue? *

Tell Us What You're Looking for in a Partnership

How soon are you looking to get new patients in your door? *

Are you looking for a partnership you can stay with for more than three months? *

What is your target monthly revenue? *

What type of condition(s) are you looking to market for? *

What is your average patient value for the condition you're looking to market? *

What is your biggest obstacle right now to hit your goals? *

Have you ever done online marketing? (If yes did it work? If not why didn't it work?) *

What is your monthly marketing budget? *

How willing and able are you to invest in the growth of your practice right now? *

I understand that a partnership takes work from BOTH of us to work long term

What Happens Next?

Once you submit the form: If you qualify, you’ll be taken to our CEO’s schedule, where you can book a call directly with him.

Fill Out the Application Below to See if you Qualify For Our Partnership System that Gets Doctors Results Year After Year!

What Happens Next?

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