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About
About Us
Testimonials
Forms
Non-Disclosure Agreement Form
Client Billing Authorization Form
Credit Card Billing Update Form
Business Info Questionnaire
Fractional CMO Client Intake Form (Dental)
Vendor Work Agreement Form
Customer Avatar form
Data Request Form
Services
Fractional CMO Service
Ecom Growth Partner (EGP) Program
Lead Eagle 1st Party Data Services
Eagle Outbound DFY Cold Email Service
Contact
Book
Search
Home
About
About Us
Testimonials
Forms
Non-Disclosure Agreement Form
Client Billing Authorization Form
Credit Card Billing Update Form
Business Info Questionnaire
Fractional CMO Client Intake Form (Dental)
Vendor Work Agreement Form
Customer Avatar form
Data Request Form
Services
Fractional CMO Service
Ecom Growth Partner (EGP) Program
Lead Eagle 1st Party Data Services
Eagle Outbound DFY Cold Email Service
Contact
Book
Search
Fractional CMO Client Intake Form (Dental)
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Fractional CMO Client Intake Form (Dental)
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Step
1
of
16
- Welcome & instructions
6%
Company
This field is for validation purposes and should be left unchanged.
Contact person completing this form
*
(Name – Required)
Best email for follow-ups
*
(Email – Required)
Best phone/text
*
(Phone – Required)
Estimate 15–25 minutes. You can Save & Continue anytime.
Legal business name
*
DBA / Patient-facing name
*
Primary location address
*
Website URL
*
Main practice phone
*
General inbox (appointments/info)
*
(Email - Required)
Practice management system
Select one ---
Open Dental
Dentrix
Eaglesoft
Curve
Other
Number of dentists / hygienists
Years in business
Office hours
Day
Open
Close
Notes
Add
Remove
Owner / Managing dentist name
*
Owner / Managing dentist email
*
Owner / Managing dentist phone
*
Marketing/office lead (day-to-day) name
*
Marketing/office lead (day-to-day) email
*
Marketing/office lead (day-to-day) phone
*
Technical / IT contact name
Technical / IT contact email
Who approves content/ads?
Owner
Office Manager
Marketing Lead
Other
Preferred approval turnaround
Select one ---
Same day
24–48h
3–5 days
Emergency comms channel
Select one ---
Email
Phone
SMS
Slack
Do you have additional locations?
Yes
No
Add locations
*
Name
Address
Phone
Booking link
Add
Remove
Which services do you offer?
General
Cosmetic
Implants
Sedation
Invisalign/Ortho
Pediatric
Endo
Perio
Oral Surgery
Emergency
Whitening
Veneers
Full-arch/All-on-X
Sleep Apnea
Other
Top 3 priority services to grow
Service 1
Service 2
Service 3
Sedation options
Nitrous
Oral conscious
IV
None
Financing options
CareCredit
Sunbit
In-house plan
Other
Insurance participation
List plans you accept; note ‘out-of-network’ if applicable.
Languages spoken
New patient special(s)
Pricing/offer, exclusions, expiration.
One-sentence value proposition
*
Why choose you?
Brand tone
Warm
Clinical
Family-friendly
Luxury
Minimally invasive
Tech-forward
Faith-friendly
Other
Top 3 differentiators
Differentiators 1
Differentiators 2
Differentiators 3
Before/after usage
Select one ---
Allowed with patient consent
Allowed anonymized
Not allowed
Logo upload
Drop files here or
Select files
Accepted file types: jpg, jpeg, png, pdf, svg, Max. file size: 128 MB.
Brand colors / fonts
Facebook Page (URL)
Instagram (URL)
YouTube (URL)
LinkedIn (URL)
Yelp (URL)
Healthgrades (URL)
Zocdoc (URL)
RealSelf (URL)
Bing Places (URL)
Apple Business Connect (URL)
Other directories
Google Business Profile (GBP) URL
*
GBP primary categories
GMB/GBP account email(s)
Which Google accounts currently own/manage your listing?
Invite our agency email to GBP
Yes, invitation sent
Google Analytics 4 (GA4) property URL
Google Tag Manager (GTM) container ID
e.g., GTM-XXXX
Google Search Console (GSC) verified?
Yes
No
Google Ads CID (if exists)
10-digit
CMS/platform
Select one ---
WordPress
Webflow
SquareSpace
Other
Admin URL
Site admin email(s)
Hosting provider
CDN/Firewall
Select one ---
Cloudflare
Sucuri
None
Other
Domain registrar
e.g., GoDaddy, Google Domains, Namecheap
DNS managed at
Select one ---
Registrar
Cloudflare
Other
SSL status
Select one ---
Auto-renew
Manual
Unknown
Staging site (URL)
Invite our agency email for access
team@leadeagle.io
Please invite this email as Admin/Manager.
Access status
Select one ---
Not invited
Invited
Access granted
Notes
Meta Business Manager URL
Pixel ID(s)
Ad Accounts (Google/Meta/Microsoft) URLs
Monthly ad budgets (by channel)
Channel
Budget
Notes
Add
Remove
Conversion goals
Calls
Form fills
Online booking
Directions
Other
Call tracking platform
Select one ---
CallRail
Invoca
None
Other
Phone numbers to track
Add
Remove
CRM / patient comms tools
Weave
Solutionreach
RevenueWell
Lighthouse 360
Podium/Birdeye
Other
Online scheduling tool
Select one ---
LocalMed
Zocdoc
Flex
None
Other
HIPAA BAA in place with these vendors?
Yes
No
Unsure
Preferred lead routing
Call
Text
Email
Scheduler link
Intake questions we must use
Review platforms to prioritize
Google
Yelp
Healthgrades
Facebook
Other
Review request system
Select one ---
Automated
Manual
None
Recent 5 great reviews
Negative review protocol
Photo/video library upload
Drop files here or
Select files
Accepted file types: zip, jpg, png, pdf, mp4, jpeg, Max. file size: 128 MB.
Patient photo/video consent process
Legal disclosures we must include
ADA accessibility statement present on site?
Yes
No
Primary service area (cities/ZIPs)
*
Top 3 competitors
Name
URL
Add
Remove
Any competitors to exclude from targeting
Monthly new-patient goal
*
Target cost per lead / per booked
Priority service split (e.g., % implants vs general)
Add
Remove
Reporting cadence preference
Select one ---
Monthly
Bi-weekly
I confirm I will invite the agency email to all accounts listed
*
Yes
Additional notes / constraints
Signature
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