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PLEASE FILL OUT THE FORM BELOW AND OUR TEAM WILL GET TO WORK ON YOUR FREE ASC MARKETING ASSESSMENT
ASC Name
*
Approximate Square Footage
*
ASC Location
*
City/State
Business Established
*
Years in existence/when established
Number of Operating Rooms
*
Number of Physicians associated with the ASC
*
Specialty
*
Please provide ASC surgical specialty (or specialties)
Most commonly performed surgical procedures
*
Please list top 3-5 in terms of frequency
Ancillary services offered at ASC
*
Please select all that apply
Physiatry/Physical Therapy services
Pain Management
Radiology
MRI
Other (please describe)
Please Describe other ancillary services
*
Marketing Information
Please describe previous or current marketing efforts and any results (good or bad), including paid search, social, television, print, and any other outbound marketing efforts.
Primary ASC Goals (short-term, long-term)
Please describe your ASCs current goals, both short term, and long term, and please include any areas of specialization you are attempting to grow or prioritize.
PLEASE FILL OUT THE FORM BELOW AND OUR TEAM WILL GET TO WORK ON YOUR FREE ASC MARKETING ASSESSMENT.
ASC Name
*
Approximate Square Footage
*
ASC Location
*
City/State
Operating Info
*
Years in existence/when established
Number of Operating Rooms
*
Number of Physicians associated with the ASC
*
Specialty
*
Please provide ASC surgical specialty (or specialties)
Most commonly performed surgical procedures
*
Please list top 3-5 in terms of frequency
Ancillary services offered at ASC
*
Please select all that apply
Physiatry/Physical Therapy services
Pain Management
Radiology
MRI
Other (please describe)
Please Describe other ancillary services
*
Additional Information
Please describe previous or current marketing efforts and any results (good or bad), include paid search, social, television, print, and any other outbound marketing efforts.
Primary ASC Goals (short-term, long-term)
Please describe your ASCs current goals, both short term, and long term, and please include any areas of specialization you are attempting to grow or prioritize.
*
Yes, I want a free intelligent ASC assessment
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