Custom Website Questionnaire (No SEO) Santa Rosa CA, PBHS

The goal of the questionnaire is to guide you through some websites focusing your attention of certain aspects of the site so that we can determine what you like and what you dislike about websites. This is your opportunity to tell us your preferences so your designer has a starting direction for your custom website design. They’ll use your comments on this questionnaire as well as their notes from your phone consultation to create a homepage for you.

#1. PROJECT CONTACT PERSON

Contact name:*

First Last

Email address:*

Contact number:*

Fax number:

Preferred Contact Method

Email
Phone
Text Message

#2. ABOUT THE PRACTICE

Doctor names & credentials:*

List doctor names with credentials in the order and as they should appear on the website. (John H. Smith, DDS, MS)

Practice name as it should appear on your website:*

Your domain name:

For example: http://www.yourdomainname.com

Email address for your Contact Us form:

For example: [email protected]

Number of office locations:*

Office address:*

Street Address Line 1 Street Address Line 2 City State / Province / Region ZIP / Postal Code

If you have more than one office location, please provide the additional addresses at the end of this form.

Office Phone Number:*

Office Hours:

List the 6 main cities that you draw patients from:

This information is used for search engine optimization.

What ethnicities are the majority of your patients?

What is the approximate age breakdown of your patients?

% Children % Adults % Seniors

#3. INFORMATION TO INCLUDE ON HOMEPAGE

Do you have a logo?*

No. My design will not use a logo.
Yes, my logo design is in process with PBHS.
Yes. My logo is attached.

Attach logo file:

Only the following file types can be attached: eps, pdf, png, jpg and gif. eps is preferred for the best quality.

Does your practice have a slogan or motto that should appear on your homepage?

Does your practice have a mission statement that should appear on your homepage?

Your current social media account links:

Please list any social media links for your practice (Facebook, Twitter, YouTube, Instagram, etc.)

Association logos to include on your homepage:

List associations you belong to that you want the logo included on your homepage, ie; ADA, ABOMS, AAE, AAOMS, etc.

Are there procedures you would like to emphasize on your site?

Popular procedures include Dental Implants, Root Canal Therapy, Wisdom Teeth Removal and Teeth Whitening, etc.

Is there anything else you'd like to emphasize on your site?

Popular topics to consider include Online Patient Registration, Free Consultation, Patient Testimonials, Office Tour, Map to Office, etc.

Did you order Launch Video?

Yes
No

Do you like the Office Overview layout?

Yes
No

Office Overview and Mission within Masthead: http://www.oralfacialsurgery.com/

Do you like the B Roll layout?

Yes
No

Office B Roll Incorporated AutoPlay within Masthead: http://www.drmoavenian.com/

Do you like the Testimonial layout?

Yes
No

Patient Testimonials Access from Home Page: https://www.westmichiganoralsurgery.com/

#4A. DESIGN PREFERENCES: THEME

The theme of the website is the main design concept and look that will be carried throughout the website. Popular choices include Scenic/Regional, Smiling People, Office/Architectural, Logo Based and Multi-Photo designs. Please take a look at the examples below to see what type of theme appeals to you.

If you would like to view additional sites we have designed, please visit our portfolio at PBHS Portfolio. If there are any sites in particular that you really like, please list them in the comments section at the end of this form, and tell us why.

PLEASE NOTE that you do not need to look at sites only in your specialty, sites design by PBHS, or in dentistry at all. Please feel free to reference non-dental and non-PBHS designed sites.

Scenic/Regional Themes

These designs feature beautiful scenic photos of your local area. Photos can be of either natural scenery or cityscapes. Photographs are often taken from a distance.

http://www.nashvilleroot.com/
http://www.newyorkendodontics.com/
http://www.lknendo.com/
http://www.infinityoralsurgery.com/

Smiling People Themes

These designs feature a variety of smiling people chosen specifically to represent your practice. You may want to show aspirational photos of beautiful models, or conversely, you may want models that represent typical people, that your patients can identify with.

http://www.oralsurgeryphoenix.com/
http://www.riversideoralsurgery.com/
http://www.chesapeakepediatricdental.com/
http://www.arbeitman-shein.com/

Office/Architectural Themes

Office/Architectural designs can feature local architecture, your office interior and/or exterior architecture or close-ups of interesting architectural features. These designs often require custom photography of your office and/or staff.

http://www.periodontalspecialty.com/
http://www.smileislanddentalgroup.com/
http://www.mw-os.com/
http://www.woodlandsofs.com/
http://www.stonebriarfaces.com/

Logo Based & Logo Combination Themes

Logo designs feature your logo prominently, and often feature a combination of your logo and smiling people, your logo with photos of your office, or your logo with local background scenery. Logo/Combination designs can be put together in any number of ways, but always feature your logo very prominently.

http://www.omfsurgery.com/
http://www.pacificofs.com/
http://www.arklatexoralsurgery.com/
http://www.drjutkowitz.com/
http://www.olympicviewdental.com/

Multi-Photo Themes

This type of design features multiple images. There can be many images or few, and often the images are direct links to corresponding topics/pages in the site.

http://www.oralsurgeryofwestchester.com/
http://www.aacmfs.org/
http://www.chapelhilloralsurgery.com/
http://www.ocosperio.com/
http://www.venturaoralsurgery.com/

Design theme preferred:

Comments:

#4B. DESIGN PREFERENCES: COLOR

You may have noticed many of our websites are blue. Blue is very relaxing for the eye and is very common in web design for that reason. You don't have to have a blue website though. Many practices choose a color scheme that matches their logo or office interior. You could design your color scheme around a favorite photo you'd like featured on your home page.

If you have a logo, the color in your logo will need to be considered when choosing a color scheme for your website. The color scheme of a website is usually one or two colors with white and possibly black. It can be bright or muted. It can have many colors that contrast with each other, or many colors that are similar to one another. It can be one bright accent color with black and white. Or it can be many shades of one color. It's important for your designer to understand what colors you like and what type of color scheme you prefer.

Please take a look at a few of the examples to see what type of color scheme generally appeals to you.

Soft/Muted Colors

Calming, hushed, subdued, dusty, quiet, gentle, soothing, reserved, empathy, mindful, caring.

http://www.coviellooralsurgery.com/
http://www.drjutkowitz.com/
http://www.srqendo.com/
http://www.kwrootcanals.com/
http://www.venturaoralsurgery.com/

Bold/Strong Colors

Striking, intense, decisive, energetic, forceful, firm, solid, stability, security, robust, substantial, reliable.

http://www.vfdental.com/
http://www.midpenperio.com/
http://www.nsperioandimplants.com/
http://www.endospecialistsfishers.com/
http://www.issaquahendodontics.com/

Bright/Cheerful Colors

Happy, clean, warm, radiant, vivid, sparkling, lighthearted, jaunty, lively, peppy, upbeat, sunny, refreshing, friendly.

http://www.hilgersorthodontics.com/
http://www.ctomfs.com/
http://www.chesapeakepediatricdental.com/
http://www.koppelmandental.com/
http://www.coastalendo.net/

Neutral Plus Colors

Calm, cool, sophisticated, clinical, collected, reserved, reliable, clean. Neutrals are commonly combined with bright accent colors.

http://www.stonebriarfaces.com/
http://www.mw-os.com/
http://www.infinityoralsurgery.com/
http://www.chilliwackoralsurgery.com/
http://www.implantasmile.com/

Type of color preferred:

Soft/Muted
Bold/Strong
Bright/Cheerful
Neutral Plus Color(s)

AND colors preferred:

Use colors based on our logo.

Use these specified colors:

#4C. DESIGN PREFERENCES: LAYOUT

Your homepage may have a minimalistic layout, or a content-rich layout. The main difference between a minimalistic and a content-rich homepage layout is the amount of information included on the homepage below the main imagery.

Please take a look at the bottom portion of the example pages and decide what approach to content appeals to you.

Minimalist Layout Examples

http://www.lknendo.com/
http://www.njsoms.com/

Content Rich Layout Examples

http://www.riversideoralsurgery.com/
http://www.oralsurgeryphoenix.com/

Homepage layout preferred:

Minimalist Layout
Content-Rich Layout

#4D. DESIGN PREFERENCES: EXAMPLES

Please list three websites you like and what you like about them. If you would like to reference sites designed by PBHS, please visit http://www.pbhs.com/portfolio/website-design-portfolio/ to review our portfolio. But remember, you do not need to reference sites designed by PBHS, or in dentistry at all. Please feel free to get ideas from non-dental sites.

Any insights into your design preferences assists in guiding your designer.

1. Website design you like:

What do you like about this site?

2. Website design you like:

What do you like about this site?

3. Website design you like:

What do you like about this site?

Are there any website features you wish to avoid, and why?

What is the primary purpose you want your website to accomplish?

Do you have any additional comments on the design or questions you'd like answered during your phone consultation?

#5. ADDITIONAL INFORMATION

Do you accept Medicare or Medicaid?*

Yes
No

Contact Information

The following is contact information that will be reflected on the Non-Discrimination page of your website. In many instances it will be the same as your normal practice information, however, in some cases it will be more specific. Please provide data for each field; all fields are required by the ADA.

Covered Entity Info

The covered entity may be your practice or your corporation.

Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax*

TTY number - if covered entity has one

Do you have 15 or more employees?*

Yes
No

Office Coordinator Info

The office coordinator is the person in your office who will be contacted by the client via the Non-Discrimination page. This could be the Office Manager, Practice Administrator, Owner of the Practice, etc.

Name*

Title*

Coordinator Email*

Additional office locations, info or questions:

#6 Office Systems & Workflows

RevenueWell + PBHS have many potential software integrated solutions to streamline office workflow from start to finish, beginning with a VOIP phone system, then online appointment scheduling, online registration forms and ending with patient reviews.

Practice Management Software

Appointment Reminder Software

Review Platforms

Other Review Software

Pre-Registration Forms

TruForm
RevenueWell Forms
Other
None

Other Registration Form

Would you like more information on any of these topics?

Yes
No

Please send me more information on:

Address

This field is for validation purposes and should be left unchanged.