Step 1 of 911%Welcome!This survey will collect all the details we need to get started on your website project. It typically takes about 30 minutes to fill out.You can save your progress and come back and finish later if you need to at any point.In this form we'll cover the following:Project LiaisonPractice DetailsSocial Media InformationCurrent Site InformationNew Site InformationSite PagesServices InformationTeam BiosPayments and Financing Details Save Form and Continue LaterProject LiaisonWith each project we recommend appointing a primary person on your team to lead the communication for your website project. This could be you or someone else.Project LiaisonPrimary Contact on your team for the website build. First Last Project Liaison Email Project Liaison Phone Save Form and Continue LaterPractice DetailsFull Practice NameDoctor's Name(s)First NameLast Name Office Email Office PhoneEmail(s) you would like your practice forms to go to. Office Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Office FaxOffice HoursWebsite Save Form and Continue LaterSocial Media InformationFacebook Twitter Instagram YouTube Google Other Save Form and Continue LaterCurrent Site InformationDo you have a domain name purchased for your site?Yes*NoI'm not sureDomain Name(s)Domain Registrar(examples: GoDaddy, BlueHost, HostGator, etc.)Username for RegistrarPassword for RegistrarWhat are some things you like about your current site?What are some things you dislike about your current site?What other websites do you like?Share some other websites to help us better understand your design aesthetic. They can be dental or otherwise. The most common one people share is apple.com. 🙂Website URL (https://www.example.com)Why do you like it? Do you have a logo?YesNoPlease upload logo files here Drop files here or Accepted file types: eps, jpg, gif, png, pdf. Save Form and Continue LaterNew Site InformationTarget DemographicPlease list demographics in area that you wish to target. Note: We will use this information for photos so please be as detailed as possible.What Patient Communication Software do you use in your practice?NoneSolution ReachRevenue WellYAPISimplifeyeWeaveLighthouse 360Dentist ChatsSomething ElseWhat Other Patient Communication Software do you use.Do you have online new patient forms you want added to your site? Yes* NoPlease provide the link or script for the online formDo you have a patient portal you want added to your site? Yes* NoPlease provide the link or script for the patient portalDo you have forms you want added that your patients can download, print & fill out at home? Yes* NoPlease upload those forms hereAccepted file types: pdf, docx. Save Form and Continue LaterPage SelectionMeet Your Team/Doctor Doctor/Team on separate pages Doctor/Team on same page Doctor(s) page onlyPhoto Gallery Option Office Tour Before & After Gallery BothPlease upload these images to your project folder. (link provided by Jameson project manager.)Patient ServicesSelect up to 3. These are the categories of services you offer. Detailed services can be selected below. General Dentistry Cosmetic Dentistry Restorative Dentistry Preventive Dentistry Children's Dentistry Technology Orthodontics Other*Please list other service categories below.Non-service Website Pages Plan Your Visit Afford Your Care About Page Contact Page FAQs Patient Testimonials Patient Resources Other*Select 2 to 4 other pages you would like to have on your website.Please list other pages you would like to have below Save Form and Continue LaterServices for new websiteGeneral ServicesSelect up to 10 services across all dental service categories. General Overview Periodontal Therapy Wisdom Teeth Removal 1 year old exams Root Canal Tooth Extraction Tooth Colored Fillings Oral Cancer Screening Nightguard NTI Mouthguard OraverseOther General Services not listed aboveCosmetic ServicesSelect up to 10 services across all dental service categories. General Overview Tooth Whitening Porcelain Veneers Prepless Veneers Porcelain Crowns Same Day Crowns EZ Pedo Crowns Porcelain Bridges Lumineers Tooth Colored Fillings Invisalign Bonding Gum Contouring Botox Juvederm Inlays/OnlaysOther Cosmetic Services not listed aboveRestorative ServicesSelect up to 10 services across all dental service categories. General Overview Implant Placement Implant Restoration Implant Supported Dentures Dentures Partial Dentures Crowns Neuromuscular Dentistry Inlays/Onlays TMJ Orthodontics-Traditional Invisalign Six Month SmilesOther Restorative Services not listed aboveTechnologySelect up to 10 services across all dental service categories. General Overview CEREC E4D Velscope Biolase Waterlase Digital X-Rays Sleep Apnea/Snoring Cosmetic Imaging Cone Beam Cambra CariFree Air Abrasion Diagnodent Intraoral Camera Digital Photography Caesey Education Sedation Dentistry IV Sedation Dentistry The WandOther Technologies not listed above Save Form and Continue LaterBio & Financial InformationDoctor Bio InformationPlease use information my current site to rewrite my bioI will send in the bio formIf we are pulling information from an existing website, review it to make sure that it is completely updated with outside continuing education courses, awards, article mentions, charity services, honors, accreditations, etc. If not, please have the doctor fill out the Doctor Bio form and send that to your Project Manager.Team Bio InformationPlease use information from my current site to rewrite biosWe will send in the bio formsIf we are pulling information from an existing website, review it to make sure that it is completely updated with outside continuing education courses, awards, article mentions, charity services, honors, accreditations, etc. If not, please have the doctor fill out the Team Bio form and send that to your Project Manager.Financial Information. Check the following if you accept: Cash Check Visa MasterCard Discover American Express CareCredit Other*Please list other Financial Options below:Finance Company Profile LinkIf you would like us to link to a patient finance company like CareCredit, etc... please provide that link. Your patient finance rep may be able to provide you with website icons/buttons and personalized links.If you offer an in-house savings plan, please provide the information you'd like on your website below:Financial & Insurance Policy I have a specific financial & insurance policy I want to include on our website. Please use the Jameson content using the above information as a guideline. Save Form and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.