Campaign Survey

We are excited work together! Make yourself comfortable and answer the following questions. If you're unsure of an answer, leave it blank and we can discuss later.

We want to guide you this quarter in choosing the highest priority campaign to best build up and nurture your current patient base relationships. We just need a little bit of information to get rocking and rolling for you.

Your Full Name *

Email *

Practice *

Choose one relationship-nurturing campaign:

Not sure which campaign is right for you? Get a Dental Intel snapshot from your Account Manager. *

How many hygiene appointments can you handle a week? *

What is the schedule? *

Who is the hygienist that the message will come from?

Do you have permission on your patient forms that patients agree to receive SMS text messages from you?

If you don't have this, that's okay. We'll send your patient base emails only. *

What is your practice management software? *

Do you have a third-party online scheduler? *

Please provide logins to let us access your LocalMed account including the multi-code for the service we're promoting *

Please provide logins to let us access your NexHealth account *

Please let us know what platform you currently use and how we can access it. *

Which Google Email would you like to sync with Roadside Connect?

If you do not have we will create one for you.

What's your new juicy offer to get patients through the door?

Your New Offer *

Are you willing to shoot a quick fun video for better conversion?

This builds stronger engagement & rapport with your patients. *

Will you take a photo of the offer? *

Submit any photos and videos here (and get excited):

Upload Your Files

I will send the files later.

Upload a pre-recorded voicemail recording here.

Upload Your Voicemail Recording

I will send the files later.

Upload your patient list (include names, emails, cell numbers) in CSV format here depending on the campaign chosen.

- For Hygiene Nurture Reactivation Campaign, send us a list of your inactive patients.

- For a Treatment Acceptance Campaign, send us a list of the patients who have not accepted treatment for the service we are targeting.

Upload your CSV or XLSX

I will send the files later.

Do you agree?

I acknowledge that the success of this campaign will depend on my team following up in a timely manner on any incoming messages and completing a training video to understand how to use the Roadside Connect platform to ensure accurate reporting of the results. *

Yes

In addition to myself, I would like the following people to be contacted if additional training or reminders are required (please provide name and preferred contact method):

Do you agree?

We will use your NAP email listed on your website for communication unless otherwise specified.

By submitting this survey, you and Roadside Dental Marketing are entering into a BAA.

Yes

Anything else?