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Blumberg Digital

Implant Funnel Discovery Questionnaire

This questionnaire helps us understand your practice and your implant offer so we can build your funnel around it.

Contact & Practice Basics

1. Main Point of Contact *

Who should we reach out to about this project?

Sent! Check your inbox for your personal link.

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2. Practice Name *

How should the practice name appear on the website?

This appears on every page and should match your Google Business Profile.

3. Existing Website *

If you already have a website, what is its address?

4. Google Business Profile *

Link to your Google Business Profile (or the Google Maps listing of your practice).

This helps us keep your name, address, and reviews consistent everywhere.

5. Locations *

Where is your practice located?

6. Phone & Office Hours *

The phone number patients should call, and your office hours.

Practice & Services

7. Practice Specialty *

Examples: general dentistry, cosmetic dentistry, orthodontics, pediatric dentistry, implant & oral surgery, periodontics, endodontics, multi-specialty, etc.

8. Services Offered *

Which services do you provide? Select all that apply.

Anything not listed above? One service per field.

9. Top Three Treatments *

Which three treatments should the website focus on most? We'll feature these most on your homepage and in Google search.

Select your services above first.

1st choice
2nd choice
3rd choice

10. Languages

Which languages does your practice serve patients in?

11. Primary Patient Types

Who are your primary patients?

Examples: families, children, seniors, professionals, implant candidates, anxious patients, cosmetic cases, etc.

Positioning

12. What Makes Your Practice Different? *

Up to three things that genuinely set you apart.

Examples: technology, sedation options, same-day crowns, in-house lab, financing, extended hours, languages, years established, etc.

13. Main Offers *

Any offers you run for patients (e.g. new patient special, free consultation). We'll feature these prominently on your website.

14. Competitors *

Two or three practices you compare yourselves against.

Brand

15. Logo *

Please upload your existing logo.

Your files are stored securely, used only to design your website, and never shared with third parties.

16. Brand Materials

Please upload any available materials related to your existing brand identity.

Examples: Brand Guidelines, Color Palette, Typography / Fonts, Business Cards, Social Media Templates, Email Signature, Printed Materials, Presentations

Your files are stored securely, used only to design your website, and never shared with third parties.

17. Colors & Fonts *

How would you like the existing color palette to be applied?

If your brand uses specific fonts, please provide the font names. One per field.

Your files are stored securely, used only to design your website, and never shared with third parties.

18. Additional Notes

Is there anything we should preserve, avoid, or improve about your current branding? Any guidelines or restrictions our design team should know about?

Creating a New Brand Identity

*

What message or impression would you like your brand to communicate to your patients?

Are there any colors you would like to use or colors you would prefer to avoid?

Are there any logos, brands, or visual identities that you like and could serve as inspiration?

Your files are stored securely, used only to design your website, and never shared with third parties.

Is there anything else you believe our design team should know before creating your new brand identity?

Are there any specific elements, symbols, or concepts you would like to include or avoid in your logo?

Examples: initials, a tooth or smile motif, natural elements, shields, stars, abstract shapes, etc.

*

Which of these website styles do you like most?

Content, Photos & Files

Everything in this section can be gathered at your own pace. Your progress is saved, and you can return with the same link at any time.

Not sure how to shoot the photos and videos? Download our Practice Photo & Video Checklist.

*

One profile per doctor. Please fill the fields rather than uploading a document.

*

The rest of the team: hygienists, assistants, front desk.

Photos of your practice: interior, exterior, signage, technology.

Your files are stored securely, used only to design your website, and never shared with third parties.

Videos of patients sharing their experience.

Your files are stored securely, used only to design your website, and never shared with third parties.

One case per entry: the treatment it shows, plus the before and after images.

Images must be of actual patients and unretouched.

Any awards, certifications, or recognitions worth showing.

Your files are stored securely, used only to design your website, and never shared with third parties.

Sponsorships, charity work, local events. Tell us and share photos.

Your files are stored securely, used only to design your website, and never shared with third parties.

*

Which payment options, insurance plans, and financing do you offer?

*

Which practice management software do you use?

Do you want patients to book appointments directly on your website?

Links to your social media profiles.

*

Where did you buy your website address (like GoDaddy), and how should we connect it when the new site launches?

Never share usernames or passwords through this form. We will arrange access securely.

Growth & Marketing

*

Roughly how many new patients does the practice see each month right now?

*

What is your target for the next 3 and 6 months?

*

Which marketing channels are you using right now?

*

Which company are you using for your marketing?

Do you already have any of these set up? Tick the ones you have.

Has anyone done SEO work on your website before?

Please fill in the required fields marked with *.