Society & Non-Dental Questionnaire Santa Rosa CA, PBHS

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.

Who is your PBHS Account Manager?

Communication Methods

Primary Contact Person*

First Last

Email to contact you*

Best number to reach you*

This could be your cell phone, and will not be used on the site

About the Business

What is your business name?*

Names and Credentials*

Please list all people as you want them listed on the website under Meet or About Us

Practice Management Software

Office Address*

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

Office Phone Number*

Office Fax Number

Do you have 2nd office?

Yes
No

2nd office address

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

Please list additional office locations in the comments field at the end of this form.

2nd Office Phone

2nd Office Fax

Do you have 3rd office?

Yes
No

3rd Office Address

Street Address Address Line 2 City State ZIP Code

If you have more than 3 offices, please use the comments section at the end of this questionnaire to list the additional office info.

3rd Office Phone

3rd Office Fax

Website Address (domain name):

If you do not already have a website address, do you have an idea of one you'd like me to register for you?

Nearby cities

Please list 6 neighboring cities from where you draw patients, for competing site verification

Project Materials

Do you have a logo?*

Yes
No
It's in process

Attach logo file

Only the following file types are allowed: eps, ai, jpg, gif, png .eps or .ai is preferred for the best quality

Alternate Logo Version

Only the following file types are allowed: eps, ai, jpg, gif, png .eps or .ai is preferred for the best quality

Do you have Social Media Accounts?

Please list any accounts that link to your practice (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 https://www.dentalfreeway.com and click on Design Choices, and then any of the specialties - it doesn't matter which one because the designs are the same among all specialties and we're only looking at layout here, not content.

Review the different designs, looking at layout of content and different features on the site - where the navigation is, how big the banner images are, placement of buttons, etc. We still start with one of these for layout, and then customize it with your content and pictures.

You can use the comment section to let us know if you have a website already with content you'd like to use, or request to use applicable stock content that we have.

Which template would you 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.

What's your 2nd choice?*

In case your first choice is already in use by another client in your area, what is your second choice?

Color preference

Do you want logo colors, bright, pastel, dark, etc.

Do you have a slogan or motto you'd like on the homepage?

Do you have a mission statement?

Do you want the mission statement on your homepage?

Yes
No

Office Email*

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.

What are your office hours?

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

Content Section

These questions pertain to the menu options (navigation) and content of your site.

Do you already have a website?*

Please list anything you'd like us to pull from your current website into your new one.

Please list pages you would like added*

Examples are: About Us, Services, Contact Us, etc.

Content Notes

Do you have any additional comments or questions pertaining to the content on your new site?

Additional Notes/Comments/Questions

Do you have any comments or questions?

What's your target activation date?

We will do our best to help you meet this timeline.

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.

What is your legal practice name?

Do You Do Business under a different name from your legal practice name? (DBA)

If yes, what is that name?

Languages Spoken In Office:

Year Practice Established:

Practice Photos

Yes
No

There are several directories that allow photos. I post the office tour photos when they’re available. May I post your personal photo?

Practice Address & Associates

Yes
No

Have you changed your address, phone number, website address or practice name or associates in the last couple of years?

Previous Practice Information

Please include old practice names, associate names, addresses and phone numbers.

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!

Address

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