New LASIK Client Questionnaire

To do our best work in setting up your new LASIK marketing solution in the most efficient way possible, we’ll need to know a bit about you and your business.


Please take a few minutes to answer these questions – the more information we have in advance, the more prepared we will be for our initial kick-off meeting, and the faster we’ll be able to implement your new system!


Thank you for choosing us as the provider for your LASIK marketing solution – we look forward to launching your new system in the near future!

Please enter your name and email address before getting started to ensure that we receive your questionnaire.
First Name
Last Name
Email Address
What is the name you prefer your practice to go by?
You will be receiving notification emails from your automation system once your entire system is launched. These notifications will require specific actions to be taken to ensure your leads receive the correct emails. Please list the first name, last name, and email address of whomever will be handling these tasks.
What is the phone number for the main LASIK contact?
What is the physical address for the location offering LASIK procedures?
Do you have multiple locations that perform LASIK sugeries? If so, please provide the location information for all additional locations. (Physical address and phone number).
What is the name of the main Doctor that performs your LASIK surgeries?
Do you have a tagline or phrase that identifies your LASIK practice?
What are some unique features of your business that separate you from your competition?
What is your geographical area of service? This would be the specific city or area that you service most regularly.
Do you perform blade free LASIK?
Please list all financing options you offer or if those options are presented on your current site, please provide the link to that page.
How many years has your Doctor been performing LASIK surgeries?
How many LASIK surgeries has your Doctor performed approximately?
How many LASIK surgeries does your Doctor perform a year approximately?
Has your Doctor had LASIK themselves?
What certifications does your Doctor have?
Has your practice or Doctor won any recent awards?
Please list the color palette you would like for your new site. Also, please explain the mood you would like your new site to convey.
Please list any fonts used in your branding.