Client Folder

Please complete the form below and click ‘Submit’ at the bottom of the page.

1. Client Name:

2. Email Address:

3. Today’s Date:

4. Client Website:

5. Have you ever had any other websites/domain names associated with your business? (Ex: Your current website is, but it used to be

6. Legal Business Name:

7. If your business has ever used a different business name, list the business name(s):

8. Business Phone Number:

9. Have you used any other phone numbers? Please list the numbers and approx. dates previous numbers were used:

10. Business Fax Number:

11. Business Address:

12. City:

13. State:

14. Zip Code:

15. If your business has multiple locations, list below along with office hours:

Business Address:

Office Hours:

16. List the tagline or slogan for your business:

17. How many pages will your site be, and what are the names of the pages?

18. Top 8 services you want to attract new patients for:

19. What major landmarks/cross streets are well-known in your area for people to use as reference points when searching for your business?

20. How should Client/Dentist/Doctor’s name be written formally on the website?

21. If you are a Doctor or Dentist, list the NPI numbers for each Dr./Dentist at the practice:

22. Off-Limit Colors for website:

23. Note that your IT contact will be responsible for giving KSM access to your current website, setting up emails, and answering all technical questions for KSM. Please list the contact information of your IT representative below:



Phone Number:

24. What is your desired call to action?

25. List of email addresses and names of people who should be included in communication with Killer Shark Marketing.

26. What is the overall look and feel you’d like to achieve?

27. Has your practice undergone a name, address, or location change in the last 10 years? This may/may not be applicable to you.

28. Do you have any new doctors that have practiced at other dental offices recently?

Please provide their full name. This may/may not be applicable to you.

29. Who are your top competitors?

30. Do you have access to your website analytics account that you can share with us?

31. List all of your active online phone numbers, and where they are used (so KS can track which phone numbers are used online):

32. Do you use call tracking? If yes, what is the login information for each online number?

33. Username/Password for domain registration:

34. List username and passwords to social accounts :

35. Are there any additional websites you own that are live on the internet other than your main website? (multiple domains may hinder rankings and be viewed as competing sites):

36. How would you describe the makeup of your client list? (age groups, income, how far are they driving to get to practice):

37. Which practice(s) account for the largest market share in your immediate area?

38. List at least one ‘new patient special’ or ‘online special’:

39. List all words we cannot use on the website (specialist, expert, etc):

40. What email address should receive online inquiries from contact forms on the website? (typically, the front desk email, or main office email receives these):

41. Please upload a high resolution version of your logo here

(file types accepted: .png, .jpg, .eps):

42. Upload Additional Marketing Material

(PDFs, Word document, Brand Guideline, Mission Statement, etc.)

43. Any additional comments or questions:

Ready to Dominate Your Competition?

And reach the top of the food chain? Fill out this form, and we’ll be in touch within 24 hours.