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The Medical Marvel - Pre Booking Form
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Full Name
First
Last
Professional Email
Mobile Number and WhatsApp
*
Speciality (e.g. General Physician, Gynaecologist, Orthopaedic)
What to up
Years in Practice (e.g. lt5 yrs, 5-15 yrs, gt15 yrs)
Less than 5 yrs
5-15 yrs
Greater than 15 yrs
Practice Setting
Solo clinic
Group practice
Hospital
City
State
Average Monthly OPD Volume estimate
What are your top 2 practice challenges? (Select up to 2)
Patient retention
Digital presence & online visibility
Workflow & SOP implementation
Team management & delegation
Personal & practice branding
Topics You'd Like to Learn (free text or pre-set options aligned to book chapters)
Consent
Receive follow-up emails
WhatsApp messages
Third Choiceinvites to webinars
Preferred Communication Channel
Email
WhatsApp
Phone
How Did You Hear About Us?
Google search
Colleague referral
social media
Event
Other
Submit
