| Please, enter the URL of a web site, which you would like to immitate in look and feel. Why do you like this site? |
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| Please, enter another URL of a web site, which you would like to immitate in look and feel. Why do you like this site? |
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| Please, enter one more URL of a web site, which you would like to immitate in look and feel. Why do you like this site? |
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| Do you have any photos or images you would like me to use on your web site? (Send them to me as an e-mail attachment) |
| YesNo |
| Do you have an account with Practice Pay Solutions, 1Shoppingcart.com, or any other e-commerce system? |
| YesNo |
| If yes, enter your provider's URL, user name and password, where I can access your account |
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| If you have any color preferences, list them here: |
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| Your web site copy is written and ready to go on your web site: |
| Less True - 1 2 3 4 5 - More True |
| What computer programs are you proficient in? |
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| Your Internet skills (e-mail, browsing, saving, etc.) is excellent: |
| Less True - 1 2 3 4 5 - More True |
| Any other comments you'd like to share with me, before I start designing your web site? |
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Your Name:
Your Email: |
