Part 1- Contact Details

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Mobile Phone Number

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* 5. Practice Name

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* 6. Practice Address

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* 7. Practice Email

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* 8. Practice Phone Number

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* 9. Practice Fax Number

Part 2- Client Profile

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* 10. What is your specialty?

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* 11. What is your title? e.g. Consultant Orthopaedic Surgeon

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* 12. What other positions do you hold? (eg. university, public hospital, research)

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* 13. Which professional associations do you hold membership? (eg. RACS, RACP, AMA)

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* 14. What conditions do you manage most frequently? Please list at least 5

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* 15. What procedures do you perform?

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* 16. Please provide a description of your practice in about 200 words for your "About Us" page

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* 17. What makes you different from other specialists in your field?

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* 18. Why do you do what you do? What made you choose your specialty or medicine? Patients want to know about your "why"

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* 19. What's your personal/ mission statement? Something to inspire trust and connection with your patients.

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* 20. What are your other consulting locations? Please give clinic name, address, phone/fax number.

Part 3- Website Information

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* 21. What domain name would you like?

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* 22. Describe the desired look and feel by using adjectives and short phrases:

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* 23. Describe your target audience/ patients:

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* 24. List 3-5 keywords patients use to search for you online eg. robotic prostate surgery

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* 25. List 2-5 websites that you like and why you like them:

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* 26. List your account links for LinkedIn/Facebook page/Twitter/Youtube/Instagram/Other:

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* 27. Do you require a new logo or logo redesign?

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* 28. Do you have professional photography of you and/or your practice?

Part 4- Website Design

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* 29. What colours would you like incorporated into your website?

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* 30. Check the 2 designs you like most from the 5 options below?

Part 5- Your Package

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* 31. What is your preferred timeframe for completing your site? (This helps us gauge your urgency. We aim to accommodate as best we can)

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* 32. I understand that managed hosting with daily backups and domain renewal is $450/year or $49/month

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* 33. Do you want to supercharge your Google ranking with our Premium SEO package?

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* 34. Is there anything else we can help you with?

Great work! You're finished! Just press the submit button below and we'll start crafting your website. You'll hear back from us very soon.

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