New Dental Development
Site Launched
Yes
No
Type Of Practice
Dentistry
Orthodontist
Dr. Name or Practice Name?
Dr. Name (Use Dr Name Content)
Practice (Use Main Content)
Name of Practice
Demo Link
Do They Have Existing Website?
Yes
No
Do They Have Access To Their Domain?
Yes
No
Who Do We Need To Contact To Find The Information On The Domain?
Website URL
Do They Have A Domain?
Yes
No
Domain Registrar Information
What Domain Would They Like to Register?
Do They Own Their Content?
Yes
No
Are We Bringing Their Existing Content over?
Yes
No
Does The Practice Have A Logo?
Yes
No
Where is their logo?
Are We Creating a Logo?
Yes
No
What Should The Logo Read?
Current Practice Address
Practice Phone Number
Email For Patients
Office Hours
Monday: 9:00am - 5:00pm Tuesday: 9:00am - 5:00pm Wednesday: 9:00am - 5:00pm Thursday: 9:00am - 5:00pm Friday: 9:00am - 5:00pm Saturday: Closed Sunday: Closed
Name of Doctors and Titles Currently At The Office
Are There Any Specialists in the Office?
Yes
No
What Specialists are in the office?
What Insurances Do You Accept?
Most PPOs
What Forms of Payment Do You Accept?
All Major Credit Cards Care Credit
Do You Have Patient Paperwork You Would Like Added to the site?
Yes
No
Do You have it on your existing site?
Yes
No (Disregard Forms)
Links of Existing Forms
ITEMS TO REMOVE (Check all services to remove)
Are You Doing General Dentistry Procedures? (Please Check All They DO NOT Do.)
Flouride Cleaning
Dental Sealants
Root Canal Therapy
What About Cosmetic Dentistry? (Please Check All They DO NOT Do.)
Veneers
Crowns
Bonding
Bridges
Dentures
Implant Placement
Implant Restoration
What About The Technology in Your Office? (Please Check All They DO NOT Do.)
IntraOral Cameras
Rotary Endodontics
Laser Dentistry
Same Day Crowns
(If using IntraOral Cameras) Are you using the iTero IntraOral Scanner?
Yes
No
Are You Using Any Brand Names? These Names Are Commonly Searched.
Enter Any Brand Names They Say If They Emphasize Anything.
Are You Providing Specialty Services At Your Office Providing Treatment Regarding: (Please Check All They DO NOT Do.)
TMJ
Sleep Apnea
Oral Surgery
Are You Practicing Sedation Techniques at the Office?
Yes
No
Are You Using Any Teeth Straightening Service? Or Clear Braces? (Please Check All They DO NOT Do.)
Invisalign
Clear Braces
Are You Providing Any Treatments Regarding Orthodontics At your Practice? (Please Check All They DO NOT Do.)
Metal Braces
Ceramic Braces
Invisalign
Damon Bracket
Lingual Braces
Aligners
TMJ
Would You Like General Information On Your Site Regarding: (Please Check All They DO NOT Do.)
Periodontics
Prosthodontics
Dentistry For Children
3 Services To Highlight
Cosmetic Dentistry Preventive Dentistry Restorative Dentistry Family Dentistry Crowns Bridges Dentures
Additional Notes
Domain Login Information
Are you happy with your current colors?
Lookup Table Items
Type a question
tel {{tel}} address {{address}} email {{email}} bname {{bname}} city {{city}} stateabr {{stateabr}} communities {{communities}} insurance {{insurance}} drname {{drname}} heshecap {{heshecap}} heshe {{heshe}} himher {{himher}} hisher {{hisher}} hishercap {{hishercap}} state {{state}}
Submit
Should be Empty: