Website Quote

This form is provided to assist you in planning a new website or modifying an existing one.

  • The form includes most of the features commonly found in health care and medical websites.
  • Your inputs will be used to create a cost estimate for your site.
  • Provide as much detail as you can and skip sections that do not apply or where you are uncertain.

Your inputs here do not constrain your future site in any way – they are used only as guidance to develop an understanding of your requirements.

Please fill in the form below and we will respond to you within 1 working day.

Many thanks for your time and interest in Wellsites

The Wellsites Team

A. Your Details

Name (required):
Email (required):
Contact Phone Number:
Business Mailing Address:
Company Name:
Type of Business:
Current website address (if any):
Preferred Contact Methods (email, phone etc):
Job Title/ Position/ Responsibilities:
How did you hear about us?
If other or personal referral, please specify

B. Budget & Timescales:

What is the estimated budget for this project?
What is your estimates start date?
Would you like a Quote?  Yes No

C. General Requirements

Please check your areas of interest:

 Considering building a new website

 Require a website in next 6 months

 Need a website ASAP

 Need to update current website

 Want our website to do more

D. Domain Name and Hosting

The address of your website on the Internet is called your 'domain name' (for example, ''). Your website files will be located on a hosting service's computer.

Do you have registered a domain name?  Yes No
If yes, enter domain name (URL)?

Do you already have a hosting service?  Yes No
If yes, enter name of hosting service:

E. Website Goals

Briefly describe the goals for the new site or upgrade:

 Educate about your company, service or product
 To generate more leads from our website
 Provide articles & information to clients
 Produce new, qualified leads
 Provide Maps and directions
 Leverage other advertising
 Provide links to other websites
 Improve customer service
 Provide a calendar
 Build an email list
 Provide online booking capability
 Answer FAQ's
 Provide clients with better tools
 Provide testimonials
 Streamline business process
 Provide audio or video
 Make life easier for everyone
 Keep customers current on changing information
 We want an online store
 Jump ahead of the competition
 Increase image / prestige of the business
 Reduce overhead (printing, postage, etc)
 We want to better integrate our website with our business process

F. Website Actions

What is the single most desired action for a visitor to take while at your website?
For example, call a phone number, fill out a form, sign up for a mailing list, make a purchase, request a free report, phone you to make a booking etc.

What other important actions are desired for your visitors to take while they are at your website?

G. Design and Layout

Please provide any information you have about the general design and appearance of your site.

Do you have an existing company logo or graphics that you wish to use?
If so, how may we obtain it (printed copy, digital copy, other)? Also indicate if you require graphic design services.

Does your business have any particular colours, symbols, shapes, images etc. that you use in other advertising that you wish to use in your website?

Briefly describe the desired 'look and feel' of your site.
For example, is your business contemporary, optimistic, conservative, serious, elegant, professional, creative, spiritual, expensive, upscale, restrained, informal, peaceful, wholesome, environmentally friendly, etc?

If you have design preferences, enter them here.
For example, you can provide the URLs of websites with design layouts that you like. Specify which elements of the examples you would like to use.

H. Website Pages

Please check the boxes below for the basic pages you need:




 About Us



 Link & Resources

 First Visit Information

 Contact Us

I. Forms

Describe any special requirements for forms (e.g. general enquiry forms, product order forms, booking forms)

J. Online Sales

 Yes No

If you plan on selling products from your website, please tell us a little about your product line, including a general description, number of categories, special ordering procedures, how many products you offer, how often products will change, and anything else that will help us analyze your e-commerce requirements.

K. Other Features

Please check any other functions that you feel you will need on your site:

 Flash or animation


 PDF download

 Feedback form from User

 Online bookings

 Photo Album / Galleries

 Email inform a friend


 Usernames & Passwords for customers

 Frequently Asked Questions

 Site Traffic Statistics

L. Additional Services

Please check any additional services you would like for your site:

 Google Adwords *

 Search Engine Listings

 Website Content Copywriting **

 Website Content Audits ***

* You may wish to use “pay per click advertising” (such as Google Adwords). Wellsites can provide consultancy to set-up & monitor this.

** Web copywriting is one of the most vital parts of a web marketing strategy. In a place where the next website is only ever a click away, it’s what you write that matters. Unfortunately web copywriting is often left to last, or left out altogether. Wellsites can help you have webcopy that works!

*** We can review your site from a content and navigation usability perspective and make strong recommendations for change – before you go and spend extra money on a redesign. It’s a bit like investing in a great road map before you head off on an unknown trip.

M. Site Administration

Some business owners prefer to make changes to their site themselves. Some would prefer us to manage the content on their behalf. Would you like us to manage some of all of the administrative capability? If yes, briefly describe the areas you would like us to manage:

N. Additional Comments

Enter additional comments here.


Thank you for taking the time to complete this form.
We will get back to you within 1 working day.