New Website Survey

Your practice has been selected for a new website! To get the project rolling and to help us understand your services, your patient demographics, and the personality of your team, please complete this survey.

TIME REQUIRED: The survey typically takes approximately 30 minutes to 1 hour to complete.

BROWSER: For best results, please use Chrome, Safari, Edge or Firefox. This form will not work with Internet Explorer (which has been replaced by Edge).

IMPORTANT: If your browser times out or you forget to hit SUBMIT at the bottom of the survey, you may lose your work. When your submission is successful, you will see this message on the screen: Thank you for completing the new website survey. We will be in touch!

Project Point Person

First & Last Name + Position

Practice Name

Practice Website URL

Files: Logo & Photography

IMPORTANT: Please be sure to add all files in the shared Google Drive link you were provided including logos, headshots, office photos, and any other assets that may be important for the new website.

Please ensure headshot file names include the name of the orthodontist or team member.

Do you have a vector file logo? (.eps or .svg NOT .png or .jpg)

Yes

Unsure

Do you have Orthodontist headshots?

Yes

Unsure

Do you have team headshots?

Yes

Unsure

Do you have office photos?

Yes

Unsure

Do you have patient photos? (eg. before and after)

Yes

Unsure

Location & Contact Information

Number of Locations

Location 1
City / Name

Google Business Profile (GBP) Link

Is GBP up-to-date? (Phone, Address, Hours)

Yes

Unsure

Phone to be displayed on the website

Email for website forms (eg. general inquiries, referrals)

Any specific neighbourhoods / areas served (downtown, west, etc.) or well-known landmarks nearby (buildings, intersections, etc.)

Location 2
City / Name

Google Business Profile (GBP) Link

Is GBP up-to-date? (Phone, Address, Hours)

Yes

Unsure

Phone to be displayed on the website

Email for website forms (eg. general inquiries, referrals)

Any specific neighbourhoods / areas served (downtown, west, etc.) or well-known landmarks nearby (buildings, intersections, etc.)

Orthodontist Information

Please provide information for each of the Orthodontists at your practice.

Orthodontist First Name

Orthodontist Last Name

Credentials (eg. DMD)

Other Credentials (eg. Invisalign Diamond Provider)

Board Certified?

Yes

Orthodontist First Name

Orthodontist Last Name

Credentials (eg. DMD)

Other Credentials (eg. Invisalign Diamond Provider)

Board Certified?

Yes

Orthodontist First Name

Orthodontist Last Name

Credentials (eg. DMD)

Other Credentials (eg. Invisalign Diamond Provider)

Board Certified?

Yes

Orthodontist First Name

Orthodontist Last Name

Credentials (eg. DMD)

Other Credentials (eg. Invisalign Diamond Provider)

Board Certified?

Yes

Team Information

If you would like a team page included on your website, please provide the names and job titles of each team member.

Team Member First Name

Position

Team Member First Name

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Team Member First Name

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Team Member First Name

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About Your Practice

Please tell us about your practice.

Office & Reception

Comfortable Seating

Children's Play Area

Entertainment (TV)

Entertainment (iPad)

Other

If other, please specify.

Location, Parking & Accessibility

Convenient Location

Accessible by Public Transit

Convenient FREE Parking

Convenient PAID Parking

Wheelchair Accessible

Other

If other, please specify.

Patient Experience

Same-Day Starts

Multiple Appointment Bookings for Families

Online Booking

Free Consultations (US)

Saturday Appointments

After School Appointments

Before School Appointments

Other

If other, please specify.

Languages Spoken

Years in Business

Are there any consistent (annual) community involvement aspects we should include on your website? (eg. proud supporter of a charity or program)

Is there anything else you'd like to add about your practice?

Financing & Insurance

In-Office Payment Plans
Do you offer In-Office Payment Plans?

Yes

If yes, please check all that apply.

0% Interest Financing

No Down Payment Options

Low Down Payment Options

If yes, how are monthly payment accepted? Check all that apply.

Pre-Authorized Debit

Credit Card

Cash

Cheque

Other

Third-Party Payment Plans
Do you offer Third-Party Payment Plans

Yes

If yes, what third-party provider do you offer?

CareCredit (US)

LendCare (Canada)

Other

If you have an application link, please provide.

If other, please specify.

Payment Methods

Cash

Cheque

Debit

Credit Card

Other

Do you offer direct billing to insurance companies?

If you do not offer direct billing, do you submit insurance claims on a patient's behalf?

Do you accept any government insurance programs? If yes, please provide details below.

Other Financial & Insurance Details

Braces & Clear Aligners

From the list below, please tell us more about the braces and clear aligners you provide.

If other, please specify:

How would you describe your approach to children's orthodontics?

Two-Phased Approach

Conservative Approach

Retainers & Post-Treatment Maintenance

What type of retainers do you offer? Check all that apply:

Fixed

Removable

Vivera

None

Other

If other, please specify:

Do you have a Smile Protection Program? If yes, please share the details. (eg. pricing information, how many years is a patient covered)

Technology

Please select the technologies that you use at your practice

X-Rays - Digital

X-Rays - Panoramic

X-Rays - Cone Beam Cat Scan

Intraoral Scanner - iTero

Intraoral Scanner - Other (Please specify below)

DentalMonitoring

SmileSnap

Virtual Consultations

Other

Other Services

Please let us know if you would like to include a dedicated page on your new website for any of the following services.

If other, please specify:

Top Services

What are the top 5 services you would like to promote on your website?

Practice Personality & 'Voice'

Do you have a motto, tagline or catchphrase that you would like to see on the website? If so, please provide it here.

Do you prefer emotive language or objective language? For example,

Emotive

Objective

A balance of both

No preference

Do you have a preference about the use of contractions? (“We’re accepting new patients” vs. “We are accepting new patients”)

Contractions are fine

Please don't use contractions

Keep contractions to a minimum

No preference

Anything else you would like us to know about how you want your practice brand portrayed online?

Patient Demographics

To help inform the types of images we'll use on your website, please provide some demographic details about your patients.

Patient Target / Age Groups (Choose all that apply)

Children

Teens

Adults

Mature Adults

Ethnicities (Caucasian, South Asian, Chinese, Black, Latino, etc.)

Are there any demographics that you would like to market to more strongly on your website?

Social Media

If you have any social media accounts you would like your new website to link to, please provide the links below.

NOTE: If you are going through the rebranding process, the Corus Marketing team will provide new social media account links.

Facebook

Instagram

Other

Your Current Website

Is the service information on your current website accurate?

Is the staff information on your current website accurate?

Please list anything specific from your old website that you would like to see on your new website:

Do you have an existing chat function you would like implemented on your new site?

Yes

Do you have patient rewards hub we need to feature on the website?

Yes

If yes, please provide the link.

Existing Vendors

Do you currently have a website vendor?

Yes

Unsure

Do you have an SEO partner?

Yes

Unsure

Anything Else?

Is there anything else you would like us to know before we start on your new website project?

Thank you for completing this form. Please take a moment to review all details before hitting submit.

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