Intake

PMHNP Websites Intake Form

We’re excited to bring your vision to life! This form helps us understand your needs so we can create the perfect website for your practice. Not sure about something? No worries—just leave it blank, and we’ll guide you!

Please complete the form to get started!

Please enable JavaScript in your browser to complete this form.

Section 1: Basic Information

Your Name

Business Name (if applicable)

Business Address (optional)

Phone

Best Email to Contact You

Preferred Website Domain (if you have one)

Do you need a new domain registered?

Section 2: Your Website Goals & Preferences

What is your website’s main purpose? (Select all that apply)

What services do you want featured? (E.g., ADHD treatment, therapy, medication management, telehealth, etc.)

Preferred Website Style

Professional & Clean
Calming & Therapeutic
Modern & Bold
Other

Preferred Color Scheme (if any)

Do you have a logo?

Yes, I will provide my logo.
No, I’d love help designing one.

Section 3: Your Website Content

How will you provide your website content?

I already have my content (Please email it to support@pmhnpwebsites.com).
I’d like sample content to modify.
I’d love help with content creation.

Tell Us About Your Practice (for the ‘About’ Page)

Any additional pages you’d like?

Would you like a blog section?

Do you have testimonials or reviews to include?

Yes (Please email them to support@pmhnpwebsites.com)
No

Section 4: Features & Functionality

Would you like animations on your website? (Choose any that apply)

Subtle motion effects
Parallax scrolling
Hover effects
No animations

Would you like us to include stock images/videos? (Up to 5 images & 2 videos free)

Do you need an online appointment booking feature?

If to Website

Would you like social media links on your site?

Would you like a business email setup? (Includes 1 free business email, extras are $10 each)

Do you need a contact form for patient inquiries?

Yes
No
Yes, but HIPAA-compliant.

Section 5: Payment & Timeline

Which payment option do you prefer?

50/50 Payment Split (50% upfront, 50% before launch)
Full Payment Upfront (Includes bonuses: 3 business emails, extra revision, priority scheduling, SEO boost).

Preferred Website Completion Date

Need a fast turnaround?

Yes, I’d like the 24-hour fast-track option.
No, I’m happy with the standard 7-day turnaround.

Section 6: Final Details

Who is your ideal patient or audience? (E.g., age group, demographics, specialty focus.)

Are there any websites you like for inspiration? (Please provide a link.)

Would you like ongoing website updates or maintenance?

No, I’ll manage updates myself.
Yes, I’d like a maintenance plan.
Yes, but only occasional updates (pricing varies).

Any additional requests, ideas, or details?

Next Steps & What to Expect After Submitting This Form

What Happens Next?

We’ll review your form and confirm receipt within 24 hours.
We’ll reach out if we have any questions and set up an onboarding call.
You’ll receive an invoice based on your selections.
Once payment is received, we’ll get started within 24 hours!
Please submit this form and any content/images to: support@pmhnpwebsites.com

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