Theme Options Welcome Questionnaire

Please provide as much detail as possible so that we can better match your vision.

"*" indicates required fields

Step 1 of 8

12%

Please describe yourself and your practice.*

What are your business hours? (If multiple locations, please list hours for each location)*

In your own words, what makes you/your practice different from any other practice in your area? (Bedside manner, Technology, Unique Services, etc.)*

(Please do not close your current browser to prevent loss of completed answers.)

Getting To Know You

Your full name as you would like it displayed on your website*

Your business name*

Address for website (all locations)*

Telephone number for website (if multiple locations, please list all Current Phone Numbers (Local and Toll Free)*

Fax number for website

Contact email address on website for patient use*

Primary contact(s) for this project (Include name, title and email for each person)*

A list of all current doctors associated with your practice*

When is your birthday?*

MM slash DD slash YYYY

If you have more than one provider, please list any additional birthdays below.

Are you board certified?*

Yes

If so, by whom?*

Please list any associations with which you are affiliated or any additional certifications.*

(Please do not close your current browser to prevent loss of completed answers.)

Website Information (If you already have one)

Website URL & any additional websites/domains you may own

Website hosting company

Website hosting company login credentials

Where is your email being hosted?

(Please do not close your current browser to prevent loss of completed answers.)

Brand Positioning

What is your practice's Mission Statement? (Why do you do what you do?)*

Let's talk about your service. What are we selling? (Both literally and figuratively. On the surface, it might be a procedure and underneath the surface, it may be confidence.)*

What is the promise your brand provides patients? How will your practice deliver on that promise?*

How would you like to be perceived through your website by potential patients/customers? (Trusting and caring, innovative and technology driven, friendly and compassionate, etc.)*

What problems does your practice solve for your patients? (What are your patients' pain points? Ex: Convenience, Specific Technology, Comfort)*

Can you give percentages of your current patients’ ethnic makeup? (i.e. 45% Caucasian, 20% Hispanic…)*

Who are your current patients? (gender, age, income level, education level, marital status, occupation, attitudes, interests, lifestyle, what procedure are they receiving? etc.)*

Who is your ideal patient? (gender, age, income level, education level, marital status, occupation, attitudes, interests, lifestyle, what procedure are they receiving? etc.)*

What are your patients' barriers to booking an appointment? (fear, procedure knowledge, cost, representation)*

(Please do not close your current browser to prevent loss of completed answers.)

Website Design

Which theme option would you like to choose for your practice? (Click Links to Preview each Theme)*

Theme Option 1: https://themeoptions1.fmbuildr.com

Theme Option 2: https://themeoptions2.fmbuildr.com

Theme Option 3: https://themeoptions3.fmbuildr.com

Will you be maintaining your current branding? (Logos, look and feel, etc.)*

Yes

N/A; No Existing Branding

If you answered yes to the previous question, please describe your branding in your own words

What colors would you like to use on your website?*

(Please do not close your current browser to prevent loss of completed answers.)

Marketing Strategy

What are your top 6 services you’d like to promote online and ideally rank for in search engines?

Service #1*

Service #2*

Service #3*

Service #4

Service #5

Service #6

What are your top 1-3 geographic targets (i.e. cities, metro areas, counties)?

Geographic target #1*

Geographic target #2

Geographic target #3

Who do you consider your top 3-5 competitors?

Competitor #1 Website URL*

Competitor #2 Website URL*

Competitor #3 Website URL*

Competitor #4 Website URL

What are your competitors' current strategies in media? What type of media are they using to market their products or services?*

What are your competitors’ strengths and weaknesses? (What potential threats do they pose?)*

What potential opportunities does this make available for you?

Do you offer free consultations?*

Yes

How do you follow up with your patients? How do you keep patients in your funnel after their office visit? (Ex: Review Requests, Email Marketing)*

(Please do not close your current browser to prevent loss of completed answers.)

Citation Development

A list of all previous doctors no longer associated with your practice, if any.

A list of previous practice locations, if any. (With full address)

A list of previous phone numbers no longer in use, if any. (Local and toll free)

If applicable, please check the following professional directory platforms you currently maintain a listing on:

RealSelf

WebMD

Vitals

HealthGrades

ZocDoc

RateMDs

Other

Please include your login credentials for RealSelf:

Please include your login credentials for WebMD:

Please include your login credentials for Vitals:

Please include your login credentials for HealthGrades:

Please include your login credentials for ZocDoc:

Please include your login credentials for RateMDs:

Please include your login credentials for other:

(Please do not close your current browser to prevent loss of completed answers.)

Your Website Content (pages with text)

Do you own the content on your current website?*

Yes

What are the top questions potential patients/clients ask you?

Question #1*

Question #2*

Question #3*

Is the content on your current site accurate, relevant and up-to-date? (Select all that apply)*

Accurate

Relevant

Up-to-date

Should the copy speak directly to or about patients?*

“You will receive care from…”

“Patients will receive care from…”

(Please do not close your current browser to prevent loss of completed answers.)

5 Tips On How To Take Great Before & After Photos (2023 Update!)

5 Types of Reviews That Can Be Removed According to Yelp Content Guidelines

How To Organically Ask Patients for Reviews

Theme Options Welcome Questionnaire

Getting To Know You

Website Information (If you already have one)

Brand Positioning

Website Design

Marketing Strategy

Citation Development

Your Website Content (pages with text)

5 Tips On How To Take Great Before & After Photos (2023 Update!)

5 Types of Reviews That Can Be Removed According to Yelp Content Guidelines

How To Organically Ask Patients for Reviews

Theme Options Welcome Questionnaire

Getting To Know You

Website Information (If you already have one)

Brand Positioning

Website Design

Marketing Strategy

Citation Development

Your Website Content (pages with text)

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