Google Ads Fine Tune On Boarding Form

First Name*
Last Name*
Email
Phone*
Address (for your practice)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Note: This information will be used in determining which areas to target for your Adwords campaign.
Other cities/towns that your clients routinely come from*

If you live in a smaller town or suburb, then clients likely come from surrounding cities or towns. Please include this information for our research. Please be realistic -- targeting too large of an area will increase your Adwords cost and decrease the click through rate of your ads. We will do additional research, but first hand location knowledge is a huge plus.
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