- Thank you for choosing PBHS to develop your internet presence. To get started, please review the following questionnaire and fill in the blanks. The typical turnaround time from when I receive this questionnaire back is 3-5 days, however additional customization or content imports may delay that a bit.
If you need any help as you fill out the questionnaire, please call 800-840-5383 and ask for your account manager.
Communication Methods
This could be your cell phone, and will not be used on the site
About the Practice
Please list all doctors as you want them listed on the website.
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Please list additional office locations in the comments field at the end of this form.
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If you have more than 3 offices, please use the comments section at the end of this questionnaire to list the additional office info.
If you do not already have a website address, do you have an idea of one you'd like me to register for you?
Please list 6 neighboring cities from where you draw patients, for competing site verification
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.
If yes, we will contact you with information and pricing to add these services.
Affordable Care Act
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.
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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.
Project Materials
Only the following file types are allowed: eps, ai, jpg, gif, png
.eps or .ai is preferred for the best quality
Only the following file types are allowed: eps, ai, jpg, gif, png
.eps or .ai is preferred for the best quality
(Facebook, Twitter, YouTube, Instagram, etc.)
Website Design Preferences
The following questions are in regard to the way the website will look and function.
Design Selection
Please go to www.dentalfreeway.com and click on Site Samples, and then your specialty. Review the different designs, looking at layout of content and different features on the site.
Keep in mind that the colors and banner images can be changed on all sites to different scenic ones, people, or even your office. So choose based on overall layout and placement of elements, not colors and banner pictures.
We will set up your chosen design with all of our default content that you see on the example. If you want to add or remove any pages from our default, please let us know in the comment section further down in this questionnaire. You can also use the comment section to let us know if you have a website already with content you'd like to use.
If you can't decide, then enter "PBHS choice" here and we'll choose a design for you. We need your logo and this questionnaire filled out with as much detail as possible in the sections below in order to choose a design.
In case your first choice is already in use by another client in your area, what is your second choice?
Do you want logo colors, bright, pastel, dark, etc.
This email address will receive the contact form submissions from your website. We recommend using a contact form instead of posting your email address, which can invite spam.
Content Section
These questions pertain to the menu options (navigation) and content of your site.
We will set up your site with our stock content as seen on the sample sites for your specialty on dentalfreeway.com. Please indicate which topics you'd like to include in your menu.
Please list anything you'd like us to pull from your current website into your new one. Typically we'll pull bios and office pictures. Anything else?
General Topics
We will automatically setup Home, Patient Information, Meet Us and Contact Us sections for you. Please indicate if you'd like these optional pages.
General Dentistry Topics
Please indicate which of the following procedural topics you'd like us to include from our stock content.
*Dentures has several sub-topics
Oral & Maxillofacial Surgery Topics
Please indicate which of the following procedural topics you'd like us to include from our stock content.
This is a partial list of specific Procedures. Please note that there are additional general overview type pages within the Dental Implants and Bone Grafting that you'll need to review once the site is posted in its temporary location.
Periodontal Topics
Please indicate which of the following procedural topics you'd like us to include from our stock content.
This is a partial list of specific Procedures. Please note that there are additional general overview type pages within the Dental Implants, Bone Grafting and Laser Therapy that you'll need to review once the site is posted in its temporary location.
Endodontic Topics
Please indicate which of the following procedural topics you'd like us to include from our stock content.
Prosthodontic Topics
Please indicate which of the following procedural topics you'd like us to include from our stock content.
This is a partial list of specific sub-topics. Please note that there are additional general overview type pages within the Dental Implants section that you'll need to review once the site is posted in its temporary location.
Pediatric Dentistry Topics
Please indicate which of the following procedural topics you'd like us to include from our stock content.
Orthodontic Topics
Please indicate which of the following procedural topics you'd like us to include from our stock content.
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Section Break
Do you have any additional comments or questions pertaining to the content on your new site?
Additional Notes/Comments/Questions
Once you're ready to go live, you can plan for approximately 2-7 business days to allow for final checks and/or domain transfers to get the site live. We will do our best to help you meet this timeline.
SEO Section - Content
We will be creating customized homepage content for your SEO campaign. Please complete the following questions so we can build content that will best represent your practice.
For Example: Experience, Staff, Service, Advanced Technology, Comfort, Top Procedures, Financing, Flexible Hours
For Example: Do you place dental implants in your office? Offer sedation services? Use certain advanced technology?
SEO - Goals
What is your primary goal?
What procedures are most important to the success of your practice. Please list in order of importance.
We will optimize for procedures, but if there are other terms that are important to your practices (i.e. top dentist, blue cross dentist, dental financing, etc.) Here is your chance to tell us what is most important to you.
For example - families, emergency patients, retired individuals, etc.
Please specify nearby cities or regions from which you expect to receive patients. Please try to keep to 5-10 locations. Go ahead and list cities, counties or communities that are appropriate for your area, in order of importance to you.
If you would like to continue using the same Analytics account you currently have, please provide your current Analytics Tracking ID (i.e. UA-12345678-1)
Directory Listings
Part of the process is submitting the site to directories. There are a few additional items that several of the major directories have space for. Please complete the items that apply.
If yes, What is that name?
There are several directories that allow photos. I post the office tour photos when they’re available. May I post your personal photo?
Have you changed your address, phone number, website address or practice name in the last couple of years?
Please include old practice names, addresses and phone numbers.
Please include their first and last name.
Additional Notes/Comments/Questions
We look closely at website visitor traffic patterns, and need to filter any traffic which comes from you or your office staff. Please go to www.myip.dk from EACH computer (although the numbers may be the same) in your office and your personal computer – List the numbers:
Please include anything you would like to discuss during your consultation or any special concerns you have.
What's Next?
Upon receipt of this questionnaire, we will post your new website on a temporary location and send you a link to review it. Please give us a call at this time so we can talk about the design customizations you'd like us to make for you.
We will also send instructions for editing the content. Please let us know if you have any questions or would like a demonstration; we will be happy to schedule some time to show you how it works.
The website can be posted at any time, so please let us know when you're ready. Allow a few days time for final site review and domain transfers to post the site.
I look forward to working with you and your practice!
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