Site Refresh Onboarding Refresh 1 Let's Get Started!2 What's New?3 Marketing Updates4 Website Updates5 About Your Services Let's get your website refreshed! Name of Practice*Main Practice Phone Number*How many locations do you have?12345678910More than 10Please complete one form for each of your locations. Is this your last location?If you have completed a form for each of your locations, select yes. Yes, I have completed a form for each of my locations. No, I still have an additional location after this one. Indicate your main locationPractice Address*Suite NumberCity*State*Zip Code*Directions to Your Practice: What is a landmark close to your location?*(i.e. We are across the street from Macy's, we are by IKEA)What cities, neighborhoods, or towns do your patients come from?*Business Hours*Enter your hours of operation below.Business Hours - NotesEnter any other additional information regarding your hours of operation, for example, if you have alternating days, lunch hours, etc.What month and year did you open your practice?*Which methods of payments do you accept?*(i.e. Cash, personal check, CareCredit, credit cards, in-house plans)Do you accept insurance? If yes, list the plans and list in-network plans you accept starting with the top five.*ProvidersHow many providers does your practice have?*-Select A Number-12345More than 5First Name*Last Name*Suffix (i.e. DDS, DMD, MAGD)*First Name*Last Name*Suffix (i.e. DDS, DMD, MAGD)*First Name*Last Name*Suffix (i.e. DDS, DMD, MAGD)*First Name*Last Name*Suffix (i.e. DDS, DMD, MAGD)*First Name*Last Name*Suffix (i.e. DDS, DMD, MAGD)*Names of Providers*Add the information about your providers.First NameLast NameSuffix (i.e. DDS, DMD, MAGD) Are any of your providers board certified?*All of our providers are board certifiedSome of our providers are board certifiedNone of our providers are board certifiedPlease list the providers that are board certified.*Which provider would you like to feature/highlight on your website?* Tell us about your marketingDo you have any affiliations, awards or achievements to include?Have you been featured in any publications? If so, which ones?What is your main message or positioning? Provide three areas of focus.(i.e. convenience, financing options, latest technology, late appointments, weekend appointments, spa-like feeling, etc.)Unique marketable attributes, amenities or services you have in your office. Add any that are not listed.* Family Scheduling Financing Options Beverage Bar Children's Play Area Extended Hours Video Games Netflix Wireless Headphones Spa Services Blankets and Pillows Massage Chairs Flat Screen TVs in Patient Rooms Music Saturday Appointments Warm, scented towels Free parking Other amenities / services you provide:Select the option that applies to you.*Closed capacity - My practice schedule is consistently full and booked out a few weeks in advanced. I have minimal to moderate open capacity.Open capacity - My practice schedule is booked consistently 1-2 days in advance with a need to fill the large open capacity.Would you like to keep the current specials on your website?*YesNoSelect three new patient call driversThese call drivers are intended to incentivize new patients to come to your office. Only $___ Adult Complete Checkup Only $___ Emergency Exam Only $___ Children Complete Checkup $___ Off Orthodontic Treatment Complimentary Cosmetic Dentistry Consult Complimentary Implant Consult Only $____ Adult Complete Checkup*We recommend starting at $69, including X-rays, exam and basic cleaning. Please give us a price point that you feel comfortable with, what is included, restrictions and ADA codes.Only $____ Emergency Exam*We recommend starting at $39, including necessary X-rays and exam. Please give us a price point that you feel comfortable with, what is included, restrictions and ADA codes.Only $___ Children Complete Checkup*We recommend starting at $49 including exam, X-rays, fluoride application and basic cleaning. Please give us a price point that you feel comfortable with, what is included, restrictions and ADA codes.$____ Off Orthodontic Treatment*We recommend starting at $100 Off. Please give us a price point that you feel comfortable with, what is included, restrictions and ADA codes.Complimentary Cosmetic Dentistry Consult*Please indicate what is included, restrictions and ADA codes.Complimentary Implant Consult*Please indicate what is included, restrictions and ADA codes.Other*List your custom call driver and indicate what is included, restrictions and ADA codes.Additional Major Changes in Your Practice* Tell us about your websiteIs there anything you DO NOT want moved from your current website?*YesNoLet us know what you DO NOT want moved from your existing site.*Add screenshots of what you DO NOT want to move overVerify email address(es) to send appointment requests*When someone requests an appointment on your website, where should we send the notification? Do you use an online scheduler to book appointments?(i.e. ZocDoc, LocalMed, DemandForce)Do you attempt to fit in same-day emergency appointments?*YesNoDo you have a dedicated emergency line?*YesNoEmergency Phone Line*Fun FactsPick 3 of the fun facts below for each doctor How many/what kind of pets do you have? Favorite kind of music? Favorite food? Favorite sports team? Do you have an unusual talent? Favorite movie? Doctor 1 - Name*Doctor 1 - Fun Facts*Doctor 2 - Name*Doctor 2 - Fun Facts*Doctor 3 - Name*Doctor 3 - Fun Facts*Doctor 4 - Name*Doctor 4 - Fun Facts*Doctor 5 - Name*Doctor 5 - Fun Facts*Your onboarding specialist will contact you to collect the fun facts from the remaining providers Tell us about your services Please only indicate services that take place in-house General DentistryWhat does your regular checkup include? Professional Cleaning Full examination Digital X-rays Traditional X-rays Oral Cancer Screening DiagnoDent Other (please specify) General Dentistry Services Amalgam Fillings Composite Fillings Oral Cancer Screening Sleep apnea - Oral Appliances Sealants Halitosis Treatment Mouth Guards - Children Mouth Guards - Adults Night Guards Inlays and Onlays Fluoride - Gel Fluoride - Foam Fluoride - Varnish Impressions - Traditional Impressions - 3-D/Digital Root Canal Treatment TMJ - Oral Appliances Other (please specify) Other(Please add specific treatments for services above. Example: for sleep apnea/snoring treatment techniques, halitosis treatments, TMJ treatment etc.)Cosmetic DentistryTeeth Whitening DaVinci KoR Zoom! Opalescence LumiBrite Pola GLO Science In-house whitening product Other (please specify) Veneers Traditional No-Prep Veneers Porcelain Composite Lumineers ProVeneer DuraThin DaVinci Veneers MAC Veneers EMAX Empress Other (please specify) Crowns & Bridges CEREC/one visit Traditional/2+ visits Porcelain Other Material (please specify) Other(Add additional services or specific treatments for services above. Example: other injectables/dermal fillers, smile makeovers, composite bonding)PeriodonticsPeriodontics Scaling and Root Planing Gum Graft Surgery Dental Crown Lengthening Gingivectomy Root Surface Debridement Laser Treatment Pocket Reduction Osseous Surgery Ridge Augmentation Ridge Preservation Regenerative Procedures Pinhole Gum Rejuvenation Sinus Lift Other (please specify) Other periodontal servicesDentures & Dental ImplantsDentures & Dental Implants Subperiosteal Implants Endosteal Implants All-on-4 Implants Teeth-in-a-Day Fixed Dentures Denture Stabilization Traditional Dentures Other (please specify) Other(Add additional services or specific treatments for services above.)OrthodonticsOrthodontics Traditional Braces Ceramic Braces Lingual Braces Damon Smile Invisalign ClearCorrect Six Month Smiles FastBraces Retainers In-house Clear Aligners Other (please specify) Other orthodontic servicesPediatric DentistryWhat is included in your complete checkup? Cleaning Full Exam Fluoride Other (please specify) Pediatric Dentistry Services Sealants Fluoride Applications Fillings Crowns Emergency Dentistry Phase 1 Ortho. Other (please specify) Other(Add additional services or specific treatments for services above.)Oral SurgeryOral Surgery Bone Grafting Wisdom Teeth Extractions Extractions TMJ Surgery Cavitation Surgery Other (please specify) Other(Add additional services or specific treatments for services above.)Anesthesia/SedationAnesthesia/Sedation Local Anesthesia Oral Sedation IV Sedation General Anesthesia Laughing Gas NuCalm Other (please specify) Other types of anesthesia/sedation methodsTechnology / SystemsTechnology / Systems DIAGNOdent The Wand SOLEA CEREC Intraoral Camera WaterLase CBCT VELscope iTero Botox Juvederm DEXIS CariVu DEXIS DEXcam Hiossen Implants LANAP Galileos 3D Imaging CAD/CAM System Other (please specify) Other TechnologiesHolistic or “Green” DentistryHolistic / Green Dentistry Silver Filling Removal Laser Bacterial Removal Healing Tooth Decay Safe Amalgam Removal Metal-Free Implants Metal-Free Fillings Mercury Removal Other (please specify) Other(Add additional services or specific treatments for services above.)OtherOther Services ConfirmationPlease review your information and then click submit.{all_fields}Submitted By* First Last Your Email*A copy of this form will be emailed to you for your records. Information Accuracy* I confirm that the information above is accurate and free of errors.
