Website Intake Questionnaire

This is everything we need to build your five custom pages. Fill out what you can — we'll follow up on anything that's missing.

8 sections. About 15-20 minutes to complete.

0% complete
01
Practice Information
This is the public-facing info that will appear on your website — your office name, location, and how patients reach you.
This helps us make sure your website handles patient information appropriately — contact forms, disclaimers, etc.
List any credentials, board certifications, or state licenses you'd like displayed on the site. These build trust with patients and help with search visibility.
01b
Domain Registration
Your domain name will be registered in your name — not ours. This means you always have full control of your web address. We need the following information for domain registration. None of this is published on your website, and we enable domain privacy so it's never visible in public records either.
If you already own a domain, enter it here. If not, tell us what you'd like and we'll check availability.

What does this mean?

Keep it where it is

You already pay someone for your domain name (like GoDaddy, Google, or your current website company). You keep paying them for the domain, and we just tell it where to point. Think of it like keeping your phone number but switching carriers. Nothing changes on your end except where the domain leads to.

Transfer it to my new hosting

We move your domain name over to your new hosting so everything is in one place. This takes about a week and we handle the whole process. You stop paying your old provider for the domain. Good if you want a clean break.

No, I need one registered for me

You don't have a domain yet, or your current website company owns it (not you). We'll register a new one in your name. You pick the name, we set it up. It's included in your annual hosting fee.

A word of caution: If you've had the same domain name for a long time, it may already have search engine value built up. Switching to a brand new domain means starting that from scratch. Before choosing a new name, seriously consider keeping your current one — even if your website company owns it, we can often help you get it transferred. We'll advise you on the best path.

I'm not sure

That's okay. A lot of people don't know who owns their domain or where it's registered. We'll figure it out together and walk you through your options. Just pick this and we'll sort it out.

02
Home Page
This is the first thing patients see. It should capture what your practice is about and why someone should choose you.
What would you want a new patient to know about your approach before they walk in the door?
Families? Athletes? Seniors? Pregnant women? Office workers? Anyone?
Something you put on business cards, signage, or marketing materials.
03
Services Page
What you offer, how you work, and what conditions you treat. This page helps patients understand what to expect and helps Google match you to the right searches.
List every technique you practice. Be specific — this helps with SEO.
Anything beyond adjustments — massage, rehab, X-ray, nutrition, decompression, cold laser, etc.
What do patients come to you for? Back pain, sciatica, headaches, sports injuries, prenatal care, pediatric issues?
04
About Page
Patients want to know who they're trusting with their care. This page tells your story — the doctors, the team, and the "why" behind your practice.
Doctor 1
Why did they become a chiropractor? What drives them? Patients connect with the person, not just the credentials.
At the end of this questionnaire, you'll have the option to upload photos. For now, just let us know if you have professional headshots available.
List any staff you'd like featured on the site — office managers, massage therapists, chiropractic assistants, etc.
When was the practice founded? Any history worth mentioning — family legacy, community roots, relocations?
If you have a mission statement or guiding philosophy, include it here. If not, describe your approach in your own words.
05
New Patient Info
This page removes the anxiety of a first visit. What should someone know before they walk in?
Walk them through it step by step — consultation, exam, X-rays, adjustment, etc.
What insurance do you accept? Do you offer cash-pay rates? Payment plans?
If you have downloadable PDF forms or an online intake system, let us know. We can link to them or integrate them into the site.
06
Contact Page
Hours, directions, and how patients can reach you. We'll also embed a Google Map of your location.
Any helpful details for finding your office — landmarks, parking lot access, which entrance to use, suite number, etc.
How do you want patients to reach you — phone call, email, contact form, online booking?
Facebook, Instagram, Google Business, etc. We'll add icons linking to your profiles.
07
Branding & Preferences
Help us match the feel of your practice. There are no wrong answers here.
If you have specific colors (from your logo, signage, or current branding), list them here. Otherwise we'll suggest something.
Pick a few words or describe the vibe.
Doesn't have to be chiropractic. If you've seen a website that felt right, paste the link here. Also include any local competitors — we want to make sure your site stands out from theirs.
Anything we didn't ask that you think is important for your site.
08
Almost done.
Two last things: submit your answers below, then upload any photos, videos, or audio files you'd like included on your site.
Upload Photos, Videos & Audio

Logos, headshots, office photos, intro videos — anything you want on your site. Accepted formats: images, video, and audio.

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