Maintaining Your Momentum

If you aspire to maximize revenues and maintain a strong schedule through the fall, follow along in our latest webinar where Ryan guides us through 5 online marketing tactics that can drive immediate demand, and help you avoid last-minute holes in your schedule despite the decrease in patient demand we anticipate to happen later this summer.

Webinar Transcription:

Let’s go ahead and begin today, we’re going to be talking about maintaining your momentum, looking at the fact the for many elective surgery, and elective medical clinics today, that coming out of the initial stages of confinement from the pandemic, that many clinics are experiencing really unprecedented demand. Tapping into the fact that there’s patients who have wanted for many months to have elective procedures are finally able to do that. Now, when we step back and reflect on it, we have to ask the question, ‘How long is that demand really going to last, and what’s going to happen with our economies as we move forward into the year?’

Now I want to address first what I think are probably some of the elephants in the room and acknowledge that there is a lot that don’t know. If we look at and we reflect on what’s happening in Europe where, in many cases, countries were affected by coronavirus ahead of North America, also where populations were both confronted by very different methods of response to the virus, but also very different social norms and how they embraced guidelines imposed by their countries. We can look at examples like France and see they had a fairly clean, what appears to be a fairly clean re-entry. They started de-confinement back in the middle of May going to full stage three de-confinement in most areas of France by June 1, and what we see is that there really has not been a significant resurgence of the virus. We have a lot of our clients and friends from Canada on the call with us today, we’re seeing fairly similar response patterns there, that are kind or warily beginning the re-entry, a little later than we’ve seen here in the United States. But of course the news today, if we step back and reflect on where we are, I think we were all very hopeful a couple of weeks ago that we were going to be able to move briskly through the stages of de-confinement. I know in my own home county here on the Central Coast of California we started de-confining over three weeks ago, and unfortunately in some areas of our county we’ve seen those numbers begin to pop back up, and I think the news this morning in the U.S. was we have 23 states who are posting record high infection numbers. Obviously there’s a correlate there to who and how many people are getting tested. This is a big unknown of exactly what the next couple of months are going to look like from one area of North America to the next.

The other big thing that we really don’t understand is what exactly is going to happen with all those people who have been laid off or furloughed during the period of sheltering in the pandemic. We as a country here in the United States, I’m just using U.S. data as a point for discussion, have seen record unemployment. I think we can safely anticipate that not all of those people will have jobs waiting for them as we continue to de-confine. It’s very unlikely that we’re going to see the record unemployment rates we had experienced in both the U.S. and Canada, as many employers either don’t reopen their doors, or find that they can do with total fewer people than they did prior to the shelter in place.

Now that said, if we reflect back to 2008, it was a period of fairly aggressive growth, especially in the area of non-surgical aesthetic services, and that people who even may have even been struggling personally financially were still finding a way to get treatments that they felt were essential to their well-being. Even though we may see a weaker economy, we may see higher unemployment, we may still see that in certain sectors of elective medicine that there is sustained demand.

The third big elephant in the room really has to do with your schedules. I struggled with when would be the right time for us to talk about these topics, because what we see as we talk to many of our clients today is that their surgery schedules, their treatment calendars are booked, and they’re booked for weeks or months in advance. It’s not universally true but right now that is fairly normal. The thing we don’t understand, the sort of unspoken question, and certainly unanswered question, ‘What happens when someone who has scheduled a tummy tuck in the anticipation that they would be able to gain access to child care suddenly confronts the reality that they’re both unemployed and unable to get the support that they need for their children? Is this going to result in cancellations, in a pattern different than what we might normally expect?’ These things are all unknown and the big question we’re going to try to answer today is, okay great, what is the responsible thing we can do as leaders in our clinic, or leaders for the marketing of our clinic, to ensure that we have something in our back pocket to maximize the likelihood that we are going to be able to attract new patients. Whether what comes next are good times, or not so good.

We’re going to run through five tactics specifically that are different from some of the long term tactics we often talk about. Different than search engine optimization which can take months, or sometime more than a year to really manifest significant improvement for the practice, or your local search optimization which similarly can take weeks to months to mature, and these are more things that you can think about that you can engage in today that are designed to bring in patients right away.

1. Earn More Reviews

So the first thing we want to talk about, and I’ll give a caveat here for the Canadians before we wrap this first section up—I want to focus on earning more reviews, and specifically use either a software tool use automation, or in-office protocols in order to focus on generating reviews on Google, and I’ll explain why we will here in just a moment.

What we know right now is that approximately 9 out of 10 patients, they’re using online reviews to evaluate physicians and influence their choices. Software advice is an organization that does this big online patient experience survey every year, their 2020 results came out just a couple of months ago and they asked the question, ‘Which review sites are most influential, are most often visited by patients?’ What was new this year is they brought Google into the mix, acknowledging that Google has really risen to the forefront as a platform for service business reviews, and what’s interesting we see is that Google in the #1 spot, we see Yelp in the #3 spot, neither of which are specific to medicine. Understanding this can help you prioritize where do you want to get the most reviews for your clinic.

What I think is really important is that it’s not just that they’re going to Google, it’s that they’re going to Google and these other review sites first. So one of the first tools that patients are using when they’re trying to find a new provider for a medical or clinical service. Obviously this is clearly influential and it’s potentially going to make or break that first impression that you’re hoping to use to attract more patients into your clinics.

Now how important is your engagement? This is especially important for our colleagues in Canada who have some prohibition against the use of reviews, they really are, patients really are looking to see that you and your clinic are actively engaged in the conversation about your reputation online. In fact, we see the vast majority would consider at least very important or moderately important. Collectively there were over 60% of patients who would expect to see you engaging and responding to what’s being said about you online.

Now it’s been a really weird period because during the pandemic, Google took action to actually freeze a business’s ability to accumulate or respond to reviews. That ban was recently lifted, they’re if not more or less business as usual, new features coming out post-covid on Google My Business, that’s the platform where your business is listed and reviewed on Google, and it’s time to essentially re-engage with Google as a platform.

Now I’m going to use, this is for my Canadian friends that are on the call here with us today, I’m going to use the College of Physicians and Surgeons out of Alberta as an example just because for me, this was the fastest of the language that I could find. But I want to acknowledge the underling truth that all across Canada, all of the colleges have a prohibition against the use of testimonials in advertising. I’m acknowledging that underlying truth, but still I want to make sure that everybody understands it doesn’t change what the consumer’s pattern is, or what the consumer’s desires are, it just changes how you ultimately need to act.

The first piece of advice, the first thing I’m recommending to everyone is just observe your local guidelines, make sure that you understand what those are, and then take the most active position that you can, specifically focusing on Google My Business to support and encourage patients to share their experiences with your clinic online for the benefit of other patients. This is the first thing what we can do that’s potentially going to have an immediate impact.

Now a side benefit for those of you that are successful in accumulating more reviews for your clinic on Google My Business, this can increase your visibility in those map-based search results, those three search results that are on the top of the page, and give you the secondary benefit of not only helping those patients who do find you feel confident in the choice and be more likely to call you, but also increase the frequency that you are found on Google.

2. Mine Your Data

Let’s pivot here and let’s talk about mining your data. This isn’t explicitly and only an online marketing tactic, but it’s an important one for us to acknowledge. We have the opportunity to either reconnect with past prospects, or send targeted communication to past patients in order to reactivate them and start old conversations or resume old treatment patterns. Let me give you some specific examples because there are two ways I want you to be thinking about this. Perhaps this is more of an intellectual or mental exercise, but I’m going to give you the boundaries of the framework to help inspire your thoughts there.

You might be thinking about, you might be focusing on encouraging re-treatment—bringing patients back who were on recurring, who would benefit from recurring treatment models, inviting and bringing them back into the practice and ensure that they stay compliant with your recommended protocol. Or, we might be focused on and thinking about reconnecting with prospective patients that we weren’t successful in attracting at some point in our practice’s history. Let’s talk about examples in both places.

What we want to do, we want to identify first and contact existing patients who are ready for re-treatment. This can be difficult to do, especially if you’re in a paper-based office or if you’re using software that’s not super supportive in doing this, but almost every clinic can successfully do this in one way or another. First place you need to look is your practice management software. Identify those particular service lines that benefit from a recurring treatment model, look at the last time that patients had those services, and patients who have effectively lapsed, who are past their recommended recurrence for their treatment, craft custom and segmented messaging to invite those people back to the office. Some offices will even use this as a time to potentially offer incentives for patients who are going to schedule to come back in right away.

Now there are some wonderful third party programs out there, for those especially in the aesthetic space, where you have industry partners who have shared access to your patient data, and I’m often startled a lot of our clients in the aesthetic space are active on Brilliant Distinctions® but very seldom use the data that is available to them there. So working with either your own access through reporting, or working through your Allergan reps to pull data of who has lapsed on their neurotoxin or filler injections. Often in those reports you can actually see who may have credits in their loyalty program that can diminish the overall cost of treatment, and inviting those people back in. Your practice management software is not your only source of data about past patients, and the places you can go to access data about prospective patients is actually potentially even bigger.

Depending on whether or not you’re using practice management software or customer relationship management software, you’re going to have access to different kinds of reporting. One of the things you might look at, first and foremost are those people who scheduled, or scheduled and completed a consultation, and either no-showed or didn’t schedule surgery. It’s an important opportunity to go back to those people who may have had a consultation with you, had every intention of getting back to you to book a procedure and then got distracted by the pandemic, to let them know that you’re back open for practice, you welcome the chance to have them come in, and either re-consult, have their first consult or schedule their service straight away.

Many of you will use lead magnets, downloadable online resources like eBooks and tools as a way to gain information or insight on patients who are considering services but not yet ready to book. It’s a great opportunity to go back into those lead magnet reports, look at and build the list of everybody who downloaded them. Very often these lead magnets can be procedure-specific, like ‘The Ultimate Guide to Lasik Surgery’ and if somebody downloaded that report you know they’re considering Lasik. Mine that group of data to send a targeted message back to them as well. In addition to that, very often your agency partners, like your team here at Etna for those of you on the call who are clients, we have often years and years of data of people who’ve requested consultations or requested more information for individual procedure lines so that you can build from that, targeted communications inviting those patients back into the clinic.

Now many of you once you have these lists together, you’re going to struggle with the idea of what do I say, and in certain cases as we’re looking to ensure HIPAA compliance, if we don’t have permission to send unsolicited marketing communications, we have to ask ourselves, what can we ethically and legally communicate. At the very least, let people know we’re open. Remind them that you’re there and able to potentially just spur the thought that it’s time to reconnect and start that new conversation. You might be surprised to find exactly how much opportunity is locked up in your own data.

3. Follow Up

Let’s talk about the third point here, and full disclosure, this really has nothing to do with online marketing, and everything to do with your operations and how you follow up. A quick reminder for those who had joined the call after we already started, the way that the webinar works today is that you’ll hear me but I will not be able to hear you. If you have questions you would like to pose in real time, just drop them into the Q&A box, click the Q&A icon, it’ll pop up a new screen and you can throw questions my way during the presentation.

Following up here is really important. This is the time, especially if it’s going to play out that we will be in a tighter economy than we expect, this is the time to demonstrate mastery in customer service and prospect follow-up. This is data that has come specifically from RealSelf, they have been gracious enough to share this with me, I’ve actually talked about this in the past because this is from a 2018 study that they did. What they specifically looked at was the number of times a clinic followed up with a prospect and how likely they actually were to connect. What they found was that clinics that were following up four times, there’s at least a handful of people on this call right now that are going ‘Four times!? We don’t even follow-up more than twice’, that follow up four times, that about 48% of those inquiries they were able to connect with, they reached roughly half the patients.

Now, they got significantly higher, they were able to reach into that 70% connection rating when they increased the number of follow-ups from 4 to 8. Now clearly it’s going to be difficult for many clinics to take every inquiry and follow up 8 times, which is why smart clinics are using CRM software and other tools to automate aspects of the follow up.

Here are my questions for you for those of you who think, ‘Oh no we’ve got follow-up down pat’, so this is what I want you to ask yourself: Can you, right now, if I put your feet to the fire and said you’ve got thirty seconds go get it, can you give me the list of everyone who has contacted your office in just the last week, take the last seven days. Can you recall, not just those people that booked, but everybody who contacted the office to inquire about a service in the last seven days, can you give me their name and at least one point of contact information, either a phone number or an email? That’s the first question to ask yourself.

Second: Can you report, for all of those people, both your last, and your next contact activity with them? If you can’t, there’s a really good chance that you could stand to benefit significantly by creating some new protocols and potentially adopting some new technology to support your team. The very first thing that you have to do is mandate that all inquiries get logged, ideally in a piece of software. Now I’ll set the exception here, someone is just calling to get directions, if they’re calling to confirm an appointment time, you don’t need to log those. We’re specifically talking here about people who are inquiring about receiving a new, or a renewed service with your clinic, That you log that information, that there are notes about that inquiring party, that you have at least one point of contact data, and that you’re setting some kind of reminder or automation of the next action that you’re going to have with that prospect. Incredibly important here to support your team.

4. Pay For Performance

Let’s talk about the fourth idea, and it’s really one of the few online tactics that we know definitely has immediacy attached to it, which is pay-for-performance or pay-per-click advertising. Now our specific advice here is that you use predictive modeling. Right, that you don’t throw darts at the wall, you don’t guess, you certainly don’t hope, but that you use predictive modeling to actually craft a winning campaign strategy that you know has a very strong likelihood of running profitably for your clinic.

So let’s talk a little bit about what that looks like, and what that means overall. I’m talking about PPC—I’m sure some of you are giving me this look right now, like PPC really—that you’ve had a bad experience in the past, that it didn’t work. The way that we overcome skepticism is with data. We use data that’s freely available to us from Google to understand the relative search volume in the specific markets that you wish to target. The average click-through-rate and the average cost-per-click when you’re buying ads for that procedure inside of that geography.

Now that tells us half of what we need to know, roughly how much it’s going to cost per click, and how many total clicks we can expect to receive based on bidding patterns in our market. But predictive modeling takes that to the next level, it’s a more responsible way to approach it.

Now this is real data, I’ll use this as an example here, for no particular reason I’m using BOTOX® as an example other than I have this data in my inbox, the data that I was just working with on the slide. We took a specific office, we drew a 40 mile radius around it, we really weren’t more discriminating about the territory, but you can and should be. Inside that there were about 4508 impressions on an average monthly basis, those are people who have searched and might be exposed to an ad with an average click through rate of 6.1% so only 6 out of 100 people who were searching in that way were going to click, when you’re willing to pay $2.69 for each and every click.

Remember a click is an inquiry, that’s just someone who is leaving Google and coming to a page that you control. This is data that we get from Google. Now we’re able to combine that with data that we know about the industry to look at once they arrive on that page that you control, what percentage of them are ultimately, likely to fill out a form, or pick up the phone and place a call to form that connection with your practice so that you at least have some hope of winning a new patient.

Let’s go back and look at this model again. What we knew from Google, we get about 4500 impressions during the month. About six in every 100 of those, if I’m paying $2.96 per click are going to click through. That’s 274 clicks that I might expect to see in that particular month, and I’m going to assume because we see this as a fairly typical landing page conversion number, that of the six people who clicked through, only 3.5% of them are then going to take the next action, contact your clinic or pick up the phone. That’s a really small number, that’s 10 inquiries out of 4500 impressions for this particular campaign.

Now we can assume for most clinics in the elective medical space, and it will vary by procedure, and market, and specialty, that about 12% of those in typical times, 12% of those who inquire will ultimately pay to have a service and complete that service at the practice which means from this campaign I have received one new patient, and I have paid $614 to get them. Now remember this is specifically for a BOTOX example, and this is often at a point that we ask, would you be willing to pay $614 for one new BOTOX patient?

Let’s pull back and reflect on this, we’ve got a great question coming in, ‘Is the data still accurate in the current crisis? I’ve heard that click-through-rates are down.’ The answer is yes, specifically the average click-through-rate, the 6.1% is down for many services in many markets, although it appears to be rebounding in real time in this month of June in many markets in North America. Interestingly in a lot of markets we’ve actually seen this other conversion metric, the visits to inquiry, slightly come up. Not enough to completely offset what we’re seeing on the top, but what I think is important to note is that you shouldn’t take this as a generalization, you need to do our predictive modeling that’s based on real and available data right now. Ideally your agency would do this for you, we do this for all of our accounts, and if we don’t get to a place where we can forecast a 5:1 return or better we won’t run the campaign. Great question Stacy, thank you very much for that.

Let’s step back because most of our clients, although we have a few who know the average lifetime value of that patient who will tell us ‘yep I’ll take BOTOX patients and I will pay $614 for them each and every day’, but most of our clients say no way, that doesn’t work for us and our economics, it needs to be significantly less but I’m not ready to give up on this yet. Instead what I’m going to do is I’m going to start to tweak the model and do some proactive optimization here.

The first thing I’m going to do is say, I’ve got to cut the average cost-per-click, $2.69 is just too much. I’m going to reduce my maximum bid down to $2.00 per click. Now when that happens, Google gives me new data and says well if that’s all you’re willing to pay, you’re not going to be seen as much, you’re only going to get 3784 impressions, and because you’re going to be positioned lower, your click-through-rate is going to be a little bit off so we’re coming down to a 5.8% click-though-rate. That’s going to reduce the total number of clicks I get down to 219.

Now at the same time, I know that if I take that campaign and I pivot away from landing them on my BOTOX page on my website, and instead I land on a built-for-purpose BOTOX landing page where the only real thing you can do on that page is either to fill out one of the forms or call the clinic, I know that I can lift my landing page conversion rate from 3.5% closer to 6%. So now we’re starting to get to a territory that’s a little bit more viable, we’ve gone from 10 to roughly 13 leads, and 1.6 new patients, rounding up, roughly two new patients and an average cast to acquire at about $279. We’ve better than halved the cost of acquisition.

Now for many clinics, this starts to look like a more attractive model, especially when what we’re evaluating isn’t that simple BOTOX treatment, but the lifetime value of that particular patient. The bottom line on that one is that the modeling works, we know that it works, I’m proud of my team back in 2018 we placed in the top 8 agencies of all the Americas for running PPC campaigns specifically to grow businesses online. That’s us right there in that short list of finalists in America’s competition that was hosted by Google. This example and the case studies that we’re able to build is part of the reason why we’ve earned that recognition with Google, and it’s part of the reason why I feel really comfortable making this recommendation for you.

There’s one important note that we’ve learned across all of the modeling that we’ve done and the big warning here is that PPC is one of those things that you either go big or you go home. The challenge that we run into with small dollar PPC campaigns is that there simply isn’t a large enough data set to get above a conversion of 1 per month, and if your likely conversion is predicted at 0.6 patients, that’s just as likely to round down to zero as it is to round up to one. If you’re spending on average we say a bare minimum for investment for PPC in most markets is $1000, most successful campaigns are running at $2000 and greater so you can’t dabble in PPC. The bottom line is you can eliminate the uncertainty, that skepticism we can potentially overcome past disappointments in PPC by first taking the time to model before you invest.

5. Plan Now For Fall Promotions

Let’s warp things up here with the fifth recommendation, and for some of you this is going to be a little bit of a controversial topic. I acknowledge that all across medicine people have different positions on the idea of promotions. I’m not necessarily going to try to change that position now but I want to share with you some examples and talk a little bit about times that you might be thinking about promotions because there certainly has, as we look back over the last two to three years, been a growing trend of seasonal promotions especially for clinics that do not want to offer any discounts or specials but are looking to see kind of a big strong end to the year. Having a one-time price adjustment attached to a big annual event. It definitely has emerged as a big trend across all of elective medicine over the last few years.

Let’s talk about a couple of examples specifically. We very often see in the Fall time frame that clinics will engage in a typical open house strategy. Obviously the challenge this year is we can’t predict how effective it’s going to be when we invite people into our space. It’s not clear as we look ahead to the fall, August, September, October, what physical adaptations we might need to make and whether people are really even going to be willing to come out. So if you’ve become reliant on an open house strategy do not wait. Start planning your alternative now because if you’re going to be forced to go virtual in one way or another, you need to probably begin building out that program today.

Now we’ve seen in addition to that, many clinics have moved to eCommerce and tied into events like Black Friday or Cyber Monday and have developed a model wherein they are using a pre-purchase model. You can get the best pricing possible of the year on specific services or service bundles when you buy them in advance online. I think for many clinics the benefit here is it’s a great cash flow strategy, you carry forward a specific liability, and it’s a great way during the rest of the year when you’re confronted by a patient who’s asking for a deal on a procedure to say well, we don’t discount during the year but we do have a big special that happens every year on either Black Friday or Cyber Monday, and let’s be sure that we have you on our email or our SMS list now so that you are certain to learn about those deals as soon as they are announced.

We see for example, Boxing Week has become a thing as we look across Canada, we see tons of seasonal promotions that happen. The twelve days of promotions that happen during the month of December as a way to wrap up the year strong. So in all of these cases as we look across these events, it’s really about taking the time to develop a careful plan to decide what it is you want to put on offer, for many clinics it’s just that time of year is when they run member drives for their VIP or their loyalty programs. You want to make sure you have the technology in place, which if you don’t already have an eCommerce platform built out now is the time to start to do that in case you need to back stock against the inability to host live meetings during the fall. And then make sure that you have everything in place so that the promotion this year is going to be more successful than it’s ever been in the past.


There are five ways that we’re talking about right now that are intended, that are designed to build and sustain this momentum, and deliver more immediate inquiries from patients. First thing to do, where you can, be sure to obverse your local guidelines, is focus on your reputation and focus specifically on earning more great reviews, representative reviews on Google.

Now the next step is to go back and look at your data. Remember it’s not just your own practice management software, but it may be your partner’s or your agency that has access to segmentable lists of patient data that you can use to mount very specific targeted messaging campaigns.

Now is the time to really make sure you are the best in your market at customer service, and that you’re following up if not aggressively, at least repetitively. That you have a clear protocol defined for your staff, that you’re measuring and monitoring that as an expectation for how you are going to service prospects because as soon as you get up to that 8 attempt mark, that’s where you’re going to see the highest likelihood that you’re reaching the largest number of prospects.

You want to take the time, if you are going to engage in PPC to do it responsibly so that you avoid, really the wasted dollar, and model in advance how you can leverage PPC for the growth and success of your business, and where you might not want to run it because it’s simply too expensive from a cost to acquire a new patient standpoint.

Finally, for those of you who are going to try to wrap up the year strong, some of the biggest momentum building things that you can do are really based on promotional moments, not necessarily live events, that correspond to the big seasonal triggers that we’re becoming more and more accustomed to like Fall open houses, those November events like Black Friday and Cyber Monday, or December holiday promotions.

If we’ve got any questions let’s drop those into the Q&A otherwise I’m going to wish you all a really happy week and a great day.

We’ve got a quick question coming in right now about the current economic downturn: So what are we hearing about how patients are prioritizing cosmetic treatments, is the market depressed or are we seeing pent up demand?

Stacy that’s a fantastic question, and what we’re seeing overall is that the vast majority of our clients are reporting unprecedented inquiry volume. That they have the combined effect of number one, the patients whose appointments were scheduled in the immediate moment attached to the shelter-in-place orders, the clinics who are right now absolutely performing the best are those that immediately pivoted to engage in virtual consultations. They added to that building backlog, they added to that new consultations that were then scheduling and booking procedures even though they couldn’t get firm dates on the schedule, they were growing the backlog. Now that practices are announcing that they are seeing patients using new, safer protocols, they’re building on top of that further with the current and immediate demand, and collectively those three things together, a lot of clinics are reporting among our client base that they are working nights and weekends, both because they’re trying to add convenience, make up for lost revenue, but frankly because the reality that it simply takes more time now to turn the office and to turn the rooms with these new safety protocols so there’s a little bit less efficiency that’s built in.

Bottom line, we’re seeing that there is indeed pent up demand, it’s the sum of those three components, but like I said in the very beginning, the elephant in the room is it’s not clear what begins to happen when we get let’s say 8 weeks into post-confinement and we worked our way through that pent up period of demand and we are perhaps operating in an economy that will, I think officially we’ve earned the status that we are in a formal depression. It’s not clear how exactly the economy will rebound.

I have observed, at least here in the U.S. that we see very erratic patient inquiry patterns during presidential election years, obviously this is going to be a very contentious election in the United States and we might see a confusing inquiry pattern where we have the combination of what’s happening with the economy, what’s happening with the pandemic, and the noise and the distraction of election activities all really creating a kind of a perfect storm here in the United States. For those that aren’t aware, in Canada they have much shorter and much more humane election cycles which I have always envied. Great question, thank you for that.

Again thank you everybody for joining us on today’s call, if you have any questions at all please go ahead and email us using the button below. We have recorded today’s presentation and will be sending the recording out to everyone here within 72 hours of today’s session. Have a great day.

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