Client Questionnaire

Our mission is to provide personalized and customized Administrative Services in order to allow our Physicians to practice Medicine more effectively. We focus on Accessibility, Accuracy and Accountability. We have the passion, experience and track record to deliver superb services. Our focus is to enable our clients to succeed, therefore assuring the highest levels of business performance, and client experience. Our overriding principle is that whatever we do should be entirely for the glory of God.

This is what AXIOM specializes in:

  • Web Design and Development
  • Search Engine Optimization (SEO)
  • Print & Graphic Design
  • Social media administration
  • Direct Mail Campaigns
  • Communication Database Management
  • Video Production and Optimization

In order to be better prepared and design a specific program for you and your practice we have compiled the following questions. These questions are to help us understand what your needs are, and how we can best assist you in meeting those needs. In addition, these questions and answers are to be kept Confidential and are to remain with the Disclosing and Recipient parties. (See Confidentiality below.)

Please fill out this questionnaire.

Name:

Email:

Phone:

URL:


  1. What state/regions/cities would you like to focus your online marketing towards?

  2. What is your ideal target audience?

  3. Where is your website hosted?
    Do you have access to it? YesNo
    Could you grant access to us?YesNo

  4. Besides your current URL, what other domains or URL’s do you own and/or operate?

    Do you use multiple domains? YesNo
    Do you have other older sites still active? YesNo

  5. How are you currently keeping track of your internet marketing results (ex. are you asking customers / clients when they call you or sign in)?

  6. Do you have any data on your sources of referrals (How did your clients/customers find out about you)?
    YesNo

  7. Are you currently using Google analytics? YesNo
    If yes, can you allow us access to the reports? YesNo
    If no, are you using any other analytic software and if so which? YesNo

  8. What is your current internet traffic like?
    Are you satisfied with the current traffic? YesNo

  9. What would be some ideal services be to focus on for keywords?

  10. Are there any specific goals you have in mind to achieve with SEO?

  11. Do you or your business have any social media accounts? (Check all that apply)
    FacebookLinkedInGoogle+TwitterPinterest
    Other:

  12. Who do you feel are your 3 biggest competitors?

    What service or "thing" separates you from those competitors?

  13. What is the end result you want from a potential customer visiting your site (ex. fill out a form; make an appointment; shop)?

  14. Is there anything in particular you feel we should know about your site to help fully optimize and market your services?

Covenant Not to Disclose Confidential Information. For purposes of this Information Exchange, "Recipient" means each party receiving Confidential Information, and "Disclosing Party" means each party submitting Confidential Information. Recipient (which shall include Representatives(as defined herein), for all purposes hereof, unless otherwise stated) agrees that the Confidential Information will be used solely for internal evaluation purposes strictly in connection with the Relationship and will be kept strictly confidential by Recipient at all times; provided, further that such Confidential Information may only be disclosed to Recipient's directors, officers, principals, agents and professional advisors (the “Representatives”), and then only to the extent which is commercially and reasonably required in respect to the evaluation of such information. Recipient will advise such Representatives of the confidential nature of the Confidential Information and shall instruct such Representatives to treat such Confidential Information as such, and obtain their acknowledgment of the terms hereof. Recipient acknowledges that Disclosing Party could be irreparably damaged if the Confidential Information which is divulged hereunder is disclosed by them or utilized on behalf of any persons other than by Recipient and the Representatives. Notwithstanding any other provision set forth in this document, it is expressly acknowledged and agreed by the parties that the obligations set forth in this document will survive the expiration and/or termination of this exchange of information in perpetuity.

Check to indicate you have read the above statement.

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