Marketing Services Questionnaire Santa Rosa CA, PBHS

This questionnaire must be completed all at once. If you are not able to complete the questionnaire due to time constraints, scroll to the bottom and submit what you have finished so far. You can revisit the other questions later or during your consultation. Please include your Name, email and website on all submissions.

Client Name*

Website*

If your site is still in development AND you do not have a website address yet, please enter http://www.nodomain.com in this field.

Email*

A copy of the questionnaire will be sent to this email address once the form is submitted

What Practice Management Software do you currently use?

Primary Contact(s)

Please include First and Last Name

Practice Info & Marketing Goals

Share information about your practice and goals.

How Do You Currently Acquire Most New Patients?

Patient Contact Email

What email address would you like your website contact form submissions(new patient leads) to be sent to? It should be an address that is monitored frequently.

Who is your target audience?

For example - Families, emergency patients, retired individuals, etc.

Please include between 3-5 competitors in your area that you feel share a target audience.

Top Procedures By Annual Revenue

What procedures are most important to the success of your practice. Please list in order of importance.

GeoLocation In Order of Importance

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.

SEO

Why did you order Search Engine Optimization?

What is your primary goal?

Additional keywords for which you would like to be found:

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.

Do You Currently Have Google Analytics Associated with Your Website?

Yes
No
I don't know

Google Analytics Tracking ID

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)

IP Addresses of your Office Computers:

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:

At what email address(es) would you like to receive your regular SEO reports?

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

Payment Accepted

Cash
Check
Visa
Mastercard
American Express
Discover
Financing
CareCredit

Year Established

Do You Want Your Office Hours Listed on Your Website and Directories

Yes
No

What are Your Office Hours?

Practice Photos

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

Yes
No

Practice Addresses

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

Yes
No

Previous Practice Information

Please include old practice names, addresses and phone numbers.

Previous Associates

Have any doctors left the practice in the last few years. We can work to close old listings referring to them at your location.

Yes
No

Please List Previous Associates

Please include their first and last name.

Would you like to be added to your Google Business Listing to receive review notifications and respond to reviews?

Yes
No

Please provide the email address for the Google Account you would like to add.

Social Media

Do you have existing social media profiles for your practice?

Check all that apply

Instagram
Facebook
I do not have social media channels

Please share links to your social media accounts

What is your primary goal for your Social Media marketing campaign?

Homepage 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.

In a few words, what would you like to convey to your target audience?

For Example: Experience, Staff, Service, Advanced Technology, Comfort, Top Procedures, Financing, Flexible Hours

Do you have a mission statement that you would like us to include?

What sets your practice apart from the rest that we can play up on the home page?

For example, do you place dental implants in your office? Offer sedation services? Use certain advanced technology?

What standard or special safety measures do you employ in your office that we can highlight?

What are the top three procedures you would like highlighted in your homepage content?

Would you like to mention, on the homepage, any prominent local organizations for which you are a provider?

Is there anything else you'd like us to know or include on your home page?

Additional Information

Additional Comments/Questions

Please include anything you would like to discuss during your consultation or any special concerns you have.

Website

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