New Website Client Intake Form | Dental & Orthodontics

1 Business Information & Goals

Business Name

Contact Person

Phone Number

Email Address

Business Address

Current Website (if applicable)

What are your top 3 priorities for this website?

Attracting new patients Showcasing services Online appointment booking SEO optimization Building credibility/reputation Other

How do most patients currently find your practice?

Google/Search Engines Social Media Referrals Paid Advertising Other

2 Design & Branding

Do you have a logo?

Yes No

Would you like us to design one?

Yes No

Do you have brand colors and fonts?

Yes No

Would you like us to assist?

Yes No

Do you have high-quality images of your practice/team?

Yes No

Would you like stock images?

Yes No

List 2-3 competitor websites you like

We'll analyze these for design inspiration and competitive positioning

3 Website Structure & Features

Do you need an online appointment booking feature?

Yes No

Which booking system do you use or prefer?

Do you need online forms?

Yes No

Do you need a HIPAA-compliant contact form?

Yes No

4 SEO & Content

Do you have existing website content?

Use my current content Write new content

What are the top 3 services or keywords you'd like to rank for?

These will guide our SEO strategy and content prioritization

Do you have testimonials or reviews you'd like featured?

Yes No

Are you interested in a blog?

Yes No

How often would you like to publish?

Weekly Monthly Quarterly

5 Locations Served

What cities/areas do you serve?

We'll create location-specific landing pages for each area to improve local SEO

What is your primary/main location?

6 Local Directories & Reputation

Are you listed on Google, Yelp, Bing, Apple Maps, or Healthgrades?

Yes No Some, but not all

Would you like us to set them up?

Yes No

Do you want assistance optimizing your online listings?

Yes No

Do you currently respond to online reviews?

Yes No Sometimes

Would you like reputation management services?

Yes No Tell me more

7 Social Media & Digital Marketing

Do you have active social media accounts?

Facebook Instagram TikTok LinkedIn YouTube None

Would you like social media integration on your website?

Yes No

Are you interested in paid advertising (Google Ads, Facebook Ads)?

Yes No Maybe later

8 Technical & Maintenance

Do you already have a domain and hosting?

Yes, I have both Domain only No

Would you like us to assist with domain/hosting?

Yes No

Do you need ongoing website maintenance?

Yes No Tell me about options

Will multiple team members need website access?

Yes No

9 Budget & Timeline

Do you have a budget range in mind?

Under $2,500 $2,500 - $5,000 $5,000 - $10,000 $10,000+

What is your ideal website launch date?

ASAP 1-2 months 3+ months

Are there any specific deadlines we should know about?

Grand Opening Rebranding Launch Other

Any additional notes or special requirements?