Custom Website Redesign Questionnaire Santa Rosa CA, PBHS

Welcome and thank you for choosing PBHS to redesign your web site. The questionnaire is the first step in your website design process. The goal of the questionnaire is to guide you through some website examples focusing your attention of certain aspects of the site so that we can determine what you like and what you dislike about websites. Our clients’ personal preferences vary widely and each client has different ideas as to what they think makes a great website. 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 the notes from your phone consultation to create a homepage for you.

If you need any help as you fill out the questionnaire, please call 800-840-5383 and ask for your account manager.

About the Practice

Practice Name

Primary Contact Person*

First Last

Email*

Contact Phone Number*

Preferred Communication Method

Email
Phone
Text
Any

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:

Affordable Care Act

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*

Project Materials

Do you have a new logo?*

Yes
No
It's in process

Do you have any new social media accounts that we don't have on your current website?

(Facebook, Twitter, YouTube, Instagram, Yelp, Reviews, etc.)

Do you want to use your same content or start with our latest stock content for your specialty?

Import my current content
Import my current content, with revisions below
Start with PBHS newest stock content

Updates from current site:

Please list any changes in doctors, office locations, procedures, etc. that are not on your current website.

Website Design Preferences

The following questions are in regard to the way the website will look and function.

Theme

The theme of the website is the main design concept and look that will be carried throughout the website. Click on the following link to review our other websites on the PBHS Portfolio*. Notice that the designs typically have scenic pictures of the area, people pictures, office pictures, etc. Determine your favorite one (or two) concepts. If there are any sites in particular that you really like, please list them in the comments section below and tell us why.

*Please note that you do not need to look at sites only in your specialty. A website theme is not based on content, so please look at a variety of specialties on our portfolio. You can also reference a non-PBHS designed site.

Theme Choice(s)*

Scenic/Regional
Logo Based
Smiling People
Office Building

Comments

Color Scheme

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 which contras each other, or many colors which 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 know which color scheme you would prefer.

Color Choices

Logo Colors

Comments

Other Questions....

What features about your current website do you like?

What features about your current site do you dislike?

What is the primary reason for your website redesign?

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

Did you order Launch Video?

Yes
No

Websites can focus on education and optimization, but at times, lack feeling. This is a missed opportunity that can be detrimental. Why? Because a website is the initial point of contact to engage patients on an emotional level It's the emotional appeal to your patients that not only deepens their relationship with you, but inspires them to explore the services you offer, such as replacing missing teeth, smiling with confidence, eating the foods a patient used to eat, that is of high value for them, and high margin for you.

Custom Video production renders a positive emotional force. It enhances your website with the ability to personally promote the uniqueness of your practice and the quality of life benefits you offer. Benefits that are reinforced by the testimonial of your existing patients.

Your Launch Videos that are being produced should be visible and easy to access on your website.

Please Review the Following Websites as examples on how your Launch Videos should be designed within your website:

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/

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

Additional Notes/Comments/Questions

Additional Info:

Get Started

Custom Website Redesign Questionnaire