* Your Name

* Medical Practice Name

* Medical Practice Location(s)

* Please provide 5-10 keywords that your patients would use to search you online?

* How do your current patients find you?

Physician Referrals Insurance Referrals Existing Patient Referrals Word-of-Mouth Marketing Leads Others?

* Do you currently have any online profiles you’ve already claimed and setup?

Google My Business Bing Local Twitter Facebook Page LinkedIn Company Page CareDash WebMD Physician Directory ZocDoc Others?

* Do you currently have any online profiles set up and claimed on online review sites?

HealthGrades Vitals RateMDs DoctorScoreCard Yelp