Section 1 of 8

Business Information

Practice/Clinic Name

Legal Business Name (if different)

Primary Contact Name

Designation

Primary Email

Secondary Email (for reports)

Primary Phone (WhatsApp)

Clinic Landline (optional)

Practice Address

Full Address

City

State

PIN Code

Google Maps Link (if available)

Years in Business

Section 2 of 8

Practice Details

Practice Type

Number of Doctors/Practitioners

All Services Offered

Top 3 Revenue-Generating Procedures

Average Case Value

Current Monthly Patients

Target Geography

Target Areas/Neighborhoods

Service Radius

Languages Spoken at Clinic

Operating Hours

Weekday Hours

Weekend Hours

Section 3 of 8

Google Business Profile Access

ℹ️ Important: Never share your Google account password. We only need to be added as a Manager to your Business Profile.

Google Business Profile Status

Current Google Rating (if known)

Google Business Profile URL (if available)

📋 How to Add Us as Manager

Go to Google Business Profile - Visit business.google.com
Select Your Business - Click on your business name
Go to "Managers" - Business Profile settings → Managers
Add New Manager - Enter: gbp@thecasebuilder.com
Select Role & Invite - Choose Manager role and click Invite

Email Address Used for GBP

Access Status

I've added gbp@thecasebuilder.com as Manager

I'll do this within 24 hours

I need help with this

Section 4 of 8

Website Access

Website URL

Website Platform

ℹ️ We'll need admin access to create treatment-specific landing pages. If you're uncomfortable sharing credentials, we can provide the pages for your developer to upload.

📋 How to Add Us (WordPress)

Login to WordPress Admin - Go to yourwebsite.com/wp-admin
Go to Users → Add New
Create New User - Email: web@thecasebuilder.com | Role: Administrator
Send Invite - Click "Add New User"

Website Access Method

I've added web@thecasebuilder.com as admin

I'll share credentials securely (we'll set up a call)

My developer will upload pages you provide

I don't have a website

Google Analytics & Search Console

Google Analytics Status

Search Console Status

Google Analytics Access

Access granted

I'll do this within 24 hours

I need help setting this up

Section 5 of 8

Social Media Accounts

Facebook Page URL

Instagram Handle

YouTube Channel

LinkedIn Page

Practo Profile

JustDial Listing

Other Review Platforms

Section 6 of 8

Competition Analysis

ℹ️ Understanding your competitors helps us identify spam listings to report and benchmark your progress.

Top 3 Competitors

What do competitors do better than you?

What do YOU do better than competitors?

Have you noticed any spam listings?

Section 7 of 8

Goals & Expectations

Target Monthly New Cases

Target Google Rating

6-Month Success Vision

Current Marketing

Current SEO/Marketing Provider

Current Monthly Marketing Budget

What's NOT worked in the past?

Section 8 of 8

Billing Information

Billing Contact Name

Billing Email

GST Number (if registered)

PAN Number

Billing Address (if different from practice)

Your Plan

Selected Plan

Preferred Billing Cycle

Additional Assets

Upload Logo (high resolution)

Upload File

Upload Clinic Photos (5-10 recommended)

Upload File

Any Additional Notes