Skip to content
AK Healthcare Website Package Order Form
ClickFirst Marketing
2023-01-23T14:39:24-05:00
Business Marketing Package Questionnaire
Step
1
of
4
25%
Your Business Name
(Required)
Your Name
(Required)
First
Last
Business Location Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
(Required)
Email
(Required)
Is your business bliling address different than the address listed above?
(Required)
Yes
No
Billing Address
Only if different than the address provided above.
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Do you want us to design a logo for you?
(Required)
Yes
No
Logo Design Information
What is the full name that you would like to appear on in the logo?
List of services and a description of what your company does:
What five words best describe your company and services?
Do you have a tagline you would like to see incorporated with the logo?
What colors do you like?
What colors do you not like?
Are there logos that you have seen that you like? Please supply URL and let us know why you like them.
Do you have any preconceived ideas about the design of your logo?
Do you want your logo to include text only, text and icon or icon only? Do you have a specific theme for your icon?
Who is your ideal customer/patient? Target audiences?
What are your company's differentiators?
Who are your top three to five competitors?
Do you have a CRM? If so, which one?
Additional Comments?
Website Content Information
Please provide the initial copy for the desired sections for your website
About Your Company
This content will appear in the About Us section of your new website.
Services Your Company Provides
Provide details your clients or customers would want to know about each service.
Contact Information
Please provide your company's contact information as you want it to appear on your website.
An Additional Section (example: Testimonials or Company Highlights)
Please upload any pictures you would like featured on the website or rack card.
If you have any difficulties uploading your files here, they can be sent via email to info@akconsultantsandhealthcare.com
Drop files here or
Select files
Max. file size: 250 MB.
Hosting & Domain Information
If you already have website hosting and a domain name for your website please provide the information below. If you don't have hosting or a domain, please skip this section. We will assist you in acquiring these.
Hosting Provider
Hosting Username & Password (For Login)
Domain Name
CAPTCHA
Page load link
Go to Top
