Custom Responsive Website Design Questionnaire

Custom Questionnaire | Solution21, Inc.

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Custom Questionnaire

Custom Responsive Website Design Questionnaire

To give us a better understanding of your requirements and practice, please fill out this questionnaire and submit to us:

Feel free to email your Designer if you have any questions

Your Name (required)

Practice Name (required)

Main contact phone (required)

Main contact email (required)


Do you own a domain name?

If yes; Please provide your website URL

Business Information

What type of audience/demographic do you have? (Age, gender, interests, etc.)

Name the cities/locations/zip codes your practice covers

What are your featured services?
Please provide a maximum of 10 featured services to use for on-page optimization.

What are your office hours?

Please list all your active professional and office affiliations

Please list all your current social media accounts

Business contact number

Business contact email

Please write any other information you would like included on your website

Design Preferences

Are there any other websites whose design/look you like?

Please indicate your competitors websites

Please indicate current office/clinic colors to connect your website to your clinic

What color theme best represents the feel you would like to convey for your practice?

Light/white colorsDark/rich colorsEarthy colorsBright ColorsI am open to different options

Your Logo:
Doctor/Staff image:
Office Photo:

Marketing Plan

Do you have a plan to promote your practice to generate leads and attract more patients to your website?

I plan on using Google AdwordsI plan on using RemarketingI plan to send email shot to my patients for my new website I plan to use Social Media and blogging. I plan to have a newsletter I do not have a plan yet

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