GP website registration arrowup6 Contact details Name of Surgery * Address * Address Address Address Address Address Address Contact Name * Contact position in Surgery * Phone * Email * Are there any other contact details you want to mention? arrowup6 Existing Web site / domain details Do you have an existing Website * Yes No What is your website url example:bemoore.com Where is your website hosted? Your website is hosted with a hosting provider. Examples are Blacknight, Letshost, hosting365, Siteground... Leave blank if not known. Hosting provider login details: Hosting Username Hosting Password Do you have an ssl cert? Yes No I don't know Do you have a domain registered? * Yes No What is your domain? Where is your domain registered? Your domain is registered with a domain registrar. Examples are Blacknight, Letshost, hosting365, Siteground... Leave blank if not known. Domain registration details: Domain registrar username Domain registrar password Do you want us to set up your web services? I want you to set up domain, hosting and ssl cert I already have a domain, I want you to set up the hosting and ssl cert. No I will do this myself Is there anything else about your existing website, domain name or ssl cert you want us to know? arrowup6 Email Do you have an email that you use for the surgery? * Yes No Which email address do you use? Which email client do you use? Examples of email clients are: gmail, outlook, yahoo. Your email client is where you go to read your email. Is some one already dealing with your email? Yes No Would you be interested in a google email? * Yes No Our team will get in touch about setting up a google email. Is there anything else you want us to know about your email? arrowup6 Website Styling Do you have a logo? * Yes No Do you want us to design a logo for you? Yes No, I have a designer to this for me. Upload your logo Drop a file here or click to upload your logo Choose File Maximum file size: 268.44MB Please upload your logo in jpeg, png or pdf format. Please be aware that if you take a photo and upload the photo, we can not guarantee the quality of the logo on the website. Do you have any specific colours or fonts you want to use in your website? If so, either describe them below or attach a copy of a brochure or letterhead. Describe colours or fonts you want to use. File Upload Drop a file here or click to upload Choose File Maximum file size: 268.44MB Upload any brochures, letter heads or any other items that can show us your prefered colours and fonts. Is there anything else you want us to know about the style of your website? arrowup6 Website Functionality Tick all the functionality you want in your website. * Order a prescription Make a payment Book an appointment Register a new patient News items Please select all that apply. Our team will be in touch to discuss your selections. Is there anything else you want us to know about the functionality of your website? arrowup6 Surgery services On the homepage of your new site is room for 6 services to be displayed with their custom icon. There will also be 6 individual pages for these services. ( any further pages can be discussed with our team) Please select up to 6 services you want displayed on your homepage. Services * General Health Children's Health Women's Health Men's Health Vaccinations Mental Health Maternity Care Healthy Lifestyle Management Family Planning Health Screening Sport Related Health Care Healthy Weight Management Sexual Health Minor Injuries Health Risk Assessment Diabetic Care Chronic Illness Care Eye Care Occupational Health Is there anything else you want to tell us about services? arrowup6 Imagery Our package includes four unique STOCK images to personalise your practice website homepage slider.Other images used will be the same as on the demo site. Please select one of the following choices: Images * I will use the 4 unique stock images included in the package I prefer to have all unique images. I understand this option will cost €1000 + vat Is there anything else you want to tell us about Images? arrowup6 SafeNsound Has the safeNsound service been explained to you? * Yes No Will you be subscribing to safeNsound? * Yes, I will subscribe to safeNsound No, I will not subscribe to safeNsound. I understand that this means I will have to maintain my site myself. arrowup6 Training We can provide you with a 60-minute copy and imagery website update training on Zoom + training manual to enable your team to make their own frontend updates. Cost for this is €500 If you prefer not to avail of this training, we can also provide for frontend copy and imagery updates on your behalf. Cost is €35 (per half hour) Training and manual * Yes, I would like to avail of the training and training manual No, the BeMoore team will do updates for me No, I do not need training, I know how to do it myself. Is there anything else you would like us to know about training and updating your website? arrowup6 The legal bits Please indicate that you are aware of / agree with: * Completion of the website will take up to 6 weeks. * A deposit of €500 is payable before work commences. * The balance of payment is due no later than 4 weeks after completion of the website. * Content for the pages and news items will be supplied by the surgery. * If I do not subscribe to the safeNsound, I am solely responsible for the maintenance and security of the website. * All the functionality of the website has been explained to me. * Costings have been provided and have been explained to me. Signature Clear Captcha If you are human, leave this field blank. Submit Δ
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