Your Discovery & Asset Gathering Checklist Step 1 of 8 12% Contact InformationName* First Last Email Address* Phone Number*Alternate Phone NumberCompany Name*Project Contact InformationDoctor's schedules can be very busy! If you are a member of his/her staff and will be our primary point of contact (POC) for this project, please provide your contact information in the fields below. As the primary POC, we’ll reach out to you first with any questions we might have.Contact Name First Last Contact PhoneContact Email How Can We Make The Scheduling Of These Meetings Easier For You?As we work together, there will be several points where we need to meet with you (or your POC) to get your input, feedback, and approval on the website design. Let us know if there are certain days and times, or any preferences you may have which will help us to help you better!Billing InformationWe have the following noted as the billing address for your account, is this correct? If not, please update below.Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Location InformationOffice Locations*We have noted the following as your office locations. Is this correct?List Of Top Three TownsWe have noted the following as the Top 3 Towns your patients may be located in. Is this correct?List Of CompetitorsNot only do we use this list to see what your competition is doing, but we also use their practice names and doctor names as negative keywords in your PPC account so we can reduce wasted ad spend and target more effectively Technical InformationWhat Is Your Current Website Address?Do You Own Multiple Domain Names (.coms, .org, etc) Besides Your Main Website Address That We Need To Know About?YesNoYour Additional Domains Please list them hereWhere Is The Site Domain Registered?For Example GoDaddy, Namesilo or NamecheapWho Is Your Web Host?For Example Godaddy, HostGator or Liquid Web HostingDoes Your Practice Have An Email Associated To The Domain? (I.E. JohnSmith@drsmithoffice.com) Social Media InformationDoes your practice have social media sites you’d like us to feature or reference on your site? If so, please provide the info noted below.Facebook LinkInstagram LinkTwitter LinkLinkedIn LinkGoogle+ LinkPinterest LinkOther Social Sites LinksWhat Email Address Would You LIke To Be Notified For New Patient Submissions VIA Website?Potential patients will be able to submit a Request Appointment form or Contact Us form on your new website. What email address or addresses do you want your contact forms to go to? Do You Have Any 3rd Party Software?Is there anything with your current website that you’re using a 3rd party for that we need to know about? (Infusionsoft, Birdeye, Solutionreach, etc) Design & ContentWhile the look of your site is definitely important, the content is even more critical. Ultimately it drives the process of generating more leads for you. Optimizing the content will begin the process of driving more traffic to your site, which means more leads and eventually, more patients.It's Possible It May Be Advantageous To Use A Portion Of Your Current Content Or Images. Is this allowed?YesNoWhat Content and/or Images Can Be Used?Do You Have Any Blogs On Your Current Website?YesNoPlease Provide A Link To Your Blogs Do You Have Any Existing Collateral Such As Brochures Or Ebooks?Do you have any reports we can use? (Ex: Does your child really need braces?, etc. )YesNoPlease Upload Your Collateral Here Drop files here or Do You Have Any New Patient Health History Forms?YesNoPatient Form InformationIf so, are these documents that you maintain or provide, or are they provided by a 3rd party?Maintained By PracticeMaintained By 3rd PartyPlease Upload Your Patient Forms HereIf they are not 3rd party and you would like to include them on your new site, please provide upload the forms here. Drop files here or Patient Form LinksPlease share 3rd party links to forms belowDo You Have A High-Resolution Version Of Your Logo?YesNoPlease Upload Your Logo Image Here Drop files here or Do You Have Any Interior Or Exterior Images Of Your Practice?Images are preferred, however, they are not needed to start your website project. We will need them no later than two weeks after your Discovery Call. We can always add to your site after launch if this deadline is missed.YesNoPlease Upload Your Practice Images Here Drop files here or Do You Have Any Images Of Your Patients?Images are preferred, however, they are not needed to start your website project. We will need them no later than two weeks after your Discovery Call. We can always add to your site after launch if this deadline is missed.YesNoPlease Upload Your Patient Images HerePlease name the pictures after the treatment received Drop files here or Do You Have Any Images Of You And/or Your Team?Images are preferred, however, they are not needed to start your website project. We will need them no later than two weeks after your Discovery Call. We can always add to your site after launch if this deadline is missed.YesNoUpload your team images herePlease name the pictures after the person Drop files here or Do You And/or Your Team Have Written Biographies?YesNoIf you have biographies in a document, upload them here. Drop files here or If you have biographies on your current website that you would like us to use, share us the link below If not, please view the link below for an example biography Click Here For Example BiographyDo You Have A Desired Color Palette You Would Like For Us To Use? Product / ServicesPLEASE NOTE - For any of the following questions, if the answers needed are already noted and accurate on your current site, you can copy/paste the link to the specifically related page in the answer field. Please Select Your Niche Below*Selecting an industry type will change the services below based on your nicheAudiologist or Hearing SpecialistDentist - General DentistDentist - OrthodontistDentist - Pediatric DentistDentist - PeriodontistOptometristPlastic SurgeonPodiatristRegenerative Medicine DoctorOrthodontic Services Provided*Please check off all the services that you provide. Invisalign Invisalign Teen Invisalign First Damon Braces Metal Damon Braces Clear Traditional Metal Insignia SureSmile Braces Clear Braces Lingual Braces Surgical Orthodontics Children's Orthodontics Other Dentistry Services Provided*Please check off all the services that you provide Dental Cleanings Pediatric Dentistry Crowns Bridges Dentures Root Canals Veneers Teeth Whitening Sedation Dentistry Invisalign Invisalign Teen Invisalign First Wisdom Teeth Gum Therapy TMJ Sleep Apnea Dental Implants All-On-Four Teeth In A Day Oral Surgery Botox & Fillers Tooth Colored Fillings Gum Treatment Recession Pinhole Gum Grafting Occlusal Adjustments Other Podiatry Services Provided*Please check off all the services that you provide Diabetic Care Wound Care Bunions Sports Injuries Toenail Fungus Heel Pain Relief Ingrown Nails Hammer & Claw Toe Nerve-Related Care Flatfoot Arthritis Skin Conditions Medical Pedicures Custom Orthotics Corns & Calluses Foot & Ankle Surgery Pediatric Foot Care Sprains Neuromas Other Audiology Services Provided* Dementia Cognitive Function Hearing Clarity Tinnitus Treatment Invisible Hearing Aids Hearing Loss Rehabilitation Hearing Protection Devices Audiology For Children Other Optometrist Services Provided* Eye Exams Contact Lens Exams Sales: Eyeglasses & Contact Lenses Managing Dry Eyes LASIK Eye Surgery Other Plastic Surgery Services Provided* Non-Surgical Facial Procedures Skincare Kybella Eyelid Lift Eyebrow Lift Earlobe Pinning Earlobe Reconstruction Facelift Rhinoplasty Arm Lift Butt Lift Thigh Lift Tummy Tuck Vaginal Rejuvenation Breast Augmentation Breast Lift Breast Reduction Breast Reconstruction Areola Reduction Nipple Reduction Inverted Nipples Breast Implant Revision Botox & Dysport Male Breast Reduction Other Regenerative Medicine Services Provided* Knee Arthritis Hip Arthritis Shoulder Arthritis Orthopedic Conditions Osteoarthritis Other Are There Any Other Services You Provide?Please list all other services you provide and/or detailed information about each.Accelerated Treatments OptionsSpeeding up the treatment process can be seen as advantageous to potential patients. For treatment options you provide, are there any that are considered accelerated? If so, please note that here. Accelerated Increase PercentageWhat percentage does each option typically speed up the treatment process? Is there documentation or website page to reference on this?What Invisalign Tier Are You?(Gold, Gold+, Platinum, Etc)?Are Retainers FREE With Treatment?What Do You Consider Your Specialty & Differentiator?What do you think you do particularly well, or take pride in? Differentiators could also be considered as your USP’s; things that make you different or unique in the eye of the patient. Do You Have A Uniquely Branded Offering? DifferentiatorsDo You Offer Evening or Weekend Appointments?*YesNoEvening or Weekend DetailsList your evening or weekend flexibilityeSchedulingCan patients schedule their appointments online?YesNoPlease Share The eScheduling Link BeloweRemindersDo you offer eReminders such as email or text messages reminding patients of upcoming appointments?YesNoPlease Share Any Information About Your eReminders BelowHow are the reminders sent? What application sends them? Any information you can provide.What Is Your Policy On Emergency Appointments?What Is Your Emergency Availability?Is There A Charge For Emergency Appointments?EnvironmentAre there things that you do to make your office more inviting to clients/patients? (For example, unique décor, fun contests, televisions, toys for kids, free WiFi, beverages, spa chairs, ear buds & music, etc.) What Are Some Advanced Technology That You Have Available?Do You Offer Any Guarantees?YesNoGuarantee Information BelowWhat guarantees do you offer? Do they have a branded name for your practice? What are the terms of your guarantees?Do You Offer Same-Day Appointments?YesNoDo Your Appointments Start On Time?YesNoPatient PortalDo you have a patient portal?YesNoPatient Portal DetailsWhat are some of the features or advantages to patients in using this portal? (For example: scheduling appointments, downloading files, accessing resources or FAQ’s, etc.)Patient Rewards ProgramDo you have a rewards program? YesNoPatient Rewards Program DetailsPlease share details of your rewards program.BilingualIs your practice bilingual?YesNoBilingual DetailsWhat languages are spoken?Is The Initial Appointment Free?YesNoWhat Service/Treatment Is Included In The Initial Appointment?Financial Value DetailsWhat is included and how much does it cost? Do You Offer Discounts? (Family, Military, Pay In Full, Etc)YesNoDiscount DetailsWhat are the details of the discounts you offer?Do You Accept Most Insurances?YesNoWhat Insurances Do You Accept?Do You Offer Payment Plans Or 0% Financing?YesNoPayments & Financing DetailsPlease explain the In-house program or through which company?General DifferentiatorsIs there anything else unusual or unique about any of the treatments you offer, services you provide or processes you use? Or, is there anything else that you see that makes you an obvious choice to a potential patient?Credibility & AuthorityYour credibility and authority can influence lead generation. Things like awards you’ve won, how long you have been in business, testimonials, how many locations you have, continuing education for you/staff, etc. are examples of information that establishes and builds credibility and authority. We’d like to highlight this type of information on your site.How many people have you helped?List the number of people helped since you have became a doctor. For Example - 600 patients per year, for 10 years... 6,000 total patients helpedSince what year?How long have you been practicing?What is your all encompassing geographical area?For Example, we are in Waterford, CT but our geographical area is called New London County. Book, Media and Community InformationBookHave you written a book?YesNoIs It Formally Published?YesNoIs It Available Digitally?YesNoShare The Digital Link BelowCan we link it on your website?YesNoMedia FeaturesYesNoPlease provide links to the featured stories, video's and/or postsHave You Treated Any Celebrities Or Respected-Local Figures In Your Community?YesNoDo You Have Their Permission To Reference Them On Your Website?YesNoDo You Have Their Permission To Use Their Image On Your Website?YesNoProvide Any Details About The Celebrities Or Respected-Local FiguresHave You Performed Any Community Service?YesNoPlease List The Name Of The Organizations And How You ParticipatedReputation / Review SystemDo you currently use any kind of system to gather reviews from your patients?YesNoWhat Is The Name Of The Reputation System That You Use?CompetitionHow do your services differ from your competitors? Given you're both selling a similar service, what makes yours worth the patient's money and not theirs? How do patients relate to you as opposed to your competition? Why did they select you over a competitor? For example, credibility or solid reputation in your community or using the latest technology. Ideal Patient InformationWhat Demographics Are You Trying To Reach?Please Describe Your Ideal PatientWhat Are The 4-5 Main Services You Would Like To Focus OnWhat Has Been The Most Valuable Approach For Generating New Patient Leads?Please Share Anything Else We Should Know About Your PatientsThat's It!If you have not already, it's a good idea to review all of your aswers entered. After you select Submit, you'll see a page with a review of what happens next. You will also be able to print a copy of the form you just completed for your own records.
