Client Signup Questionnaire :
This is just a questionnaire so we can get an idea of what you would like for your website. You will not be charged anything until we have discussed your need and you are ready to proceed.
Step 1 : Provide Your Contact Details
First Name :
Last Name :
Email Address :
Mobile Phone Number :
Practice Name :
Practice Address :
Practice Phone Number :
Step 2 : Design Preference
(Choose 3 designs from the options below that you like. This will align our design with your preference.)
Step 3 : Basic Client Profile
(This information will be shown on your new website.)
Do you currently have a website? URL :
If you require a new domain, please choose the type you would like (subject to domain availability)
- Your name (eg. Dr XavierChia .com.au)
- Practice name (eg. CardioSA.com.au)
- Others (Please provide)
Do you require a new logo or logo redesign? (Additional costs will apply.)
Do you have professional photography of you and/or your practice?
Describe the desired look and feel by using adjectives and short phrases:
Are there any colours that you want incorporated into your website?
What is your specialty?
When did you commence private practice?
What other positions do you hold? (eg. university, public hospital, research)
Which professional associations do you hold membership? (eg. RACS, RACP, AMA)
What conditions do you manage often? Eg. Types of Treatment.
What procedures do you perform?
What do you want your site to convey?
Please provide a 200 word description of your practice :
(For use in About Us page)
What makes you different from other specialists in your field?
Describe your target audience/patients?
List 5 important keywords you want people to associate with your organisation’s image and brand?
What is your preferred timeframe for completing the site?
(This only helps us gauge your urgency. It is not a commitment to service.)
$2950 one-time then $47/month or $450/year hosting*.
(*Hosting includes updates, security & website management)
Free Domain* OR Your Own Domain Name
Complete Functional Custom Website
Uniquely Designed To Suit Your Practice & Specialty.
Premium 1st Month SEO Service
Professionally Written SEO Articles
Lead Generation Form On Homepage
Click To Call Button Integration
Website Analytics & Tracking
Email Autoresponder And Lead Forwarding
Full Ownership Of Your Website And Domain
Optional Add-Ons :
Logo Design $100
SEO Optimised Articles By Medical Writers $100 ea**
Professional Photography (10 Shots) $600-900*
Adwords PPC Campaign Setup (From $1200)