Namavio · New Client Intake

Tell us about your practice

Practice / Clinic Name *

Your Name (Contact) *

Email Address *

Phone Number

Specialty / Practice Type *

Number of Providers

Number of Locations

Current EMR / Practice Management System

Your current website

Do you currently have a website?

Hosting, platform & migration

This tells us what we're migrating away from and how to handle your domain transfer to Cloudflare.

Where is your site currently hosted?

What platform/builder was it built on?

Where is your domain registered?

Do you have login access to your current site/host?

Migrate existing content to the new site?

Revenue, operations & baseline

This is how we calculate your ROI. The more honest your estimates, the better we can show what a better patient front door is worth to you.

Appointment Volume

Approximate monthly appointment volume

Estimated no-show / cancellation rate

Approximate unfilled appointment slots per month

Average revenue per visit (all-in)

Front Desk & Phone

How many front desk / admin staff?

What % of inbound calls go to voicemail or are missed?

What's the biggest front desk burden right now?

Online Reputation

Current Google Rating (e.g. 4.2)

Approximate number of Google reviews

Actively responding to Google reviews?

Payer Mix & Demographics

Payer mix

Primary patient demographics (select all)

Predominantly Spanish-speaking Predominantly English-speaking Mixed bilingual Skews older (55+) Skews younger (under 40) Pediatric / families Broad mix

Goals & pain points

Primary goals for the new site (select all)

Attract more new patients Modernize the online presence Add online scheduling / appointment requests Automate intake paperwork Capture insurance info upfront Get more Google reviews Reduce front desk call volume Look more credible vs. competitors Other

In your own words — what's your biggest frustration with how new patients find and interact with your practice today?

Current patient panel size

New patients per month goal

90-Day Success Definition

How will you know this worked in 90 days?

If you could pick ONE metric to prove ROI, what would it be?

Features & capabilities

Scheduling preference

How do patients fill out intake forms today?

Capture insurance info during online scheduling?

Do you offer telehealth?

Design & branding

Color preferences for your website?

Logo status

Style vibe (pick all that fit)

Clean & modern Warm & welcoming Corporate / professional Bold & colorful Soft & calming Minimal / simple

Design notes, inspiration sites, or hard no's

Content & Photo Assets

Do you have professional photos of providers and the office?

Future services & scaling

No commitment — this helps us build your growth roadmap beyond the website launch.

Specific growth challenges we should know about?

Timeline, budget & next steps

When do you need the site live?

Which Namavio plan are you considering?

Are you the decision maker?

Any concerns about patient data going through third-party platforms?

Other vendors / agencies you're evaluating

How did you hear about Namavio?

Anything else before the discovery call?

Let's build your clinic's online presence