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Where Does Your Business Rank
Client Login
On-Boarding Form - Location
Submit Business Location Details
Please fill in the details below.
Important, Please Read Before Continuing
If you have more than one location, please fill out this form once for each location
Your business name, phone number and address should all be exactly as you want them displayed on your website and other public directory websites (Yelp, Yellow Pages, etc.).
Your SCW Customer Number (Provided in your welcome email and also located on your receipts) - NOT USED ONLINE
(Required)
Ex. scw123
Your Name (Person filling out this form) - PRIVATE - NOT USED ONLINE
(Required)
First
Last
Your Email - PRIVATE - NOT USED ONLINE
(Required)
Your Phone Number - PRIVATE - NOT USED ONLINE
(Required)
SMS Lead Notifications - Check the box to Enable
I would like to be notified at this number via SMS about new leads
Business Owner Name
(Required)
First
Last
This field is hidden when viewing the form
Geocoder - SCW Onboarding
Business Name (If your exact business does not auto populate, leave this field blank and check the box below.)
My Business is not populating in the above Google Form
Business Name (Use this business name fields and make sure the one above is blank)
(Required)
This field is hidden when viewing the form
Business Address Street Number - Hidden
This field is hidden when viewing the form
Business Address Street Name - Hidden
This field is hidden when viewing the form
Business Address Line 2 - OLD
This field is hidden when viewing the form
Premise ????
Business Address Line 1
Business Address Line 2
Business City
Business State
Business Zip
Business Phone Number
(Required)
Business Website URL / Address (If you are a multiple location business - please provide the URL to the individual location page if you have those)
(Required)
Public Facing Business Email
(Required)
Social Media URL's (Put NONE if you haven't created any)
(Required)
Please list as many as possible
Fax Number
Facility License Number
Number Of Employees
(Required)
Year Company Was Founded
(Required)
Business Slogan / Tagline
Payment Methods Accepted - Include All
Hours of Operation
(Required)
Please list any previous business addresses & phone numbers used
(Required)
Number of Beds
(Required)
Services Offered
(Required)
Assisted Living
Memory Care
Independent Living
Dementia Care
Alzheimer’s Care
Hospice Care
Diabetic Care
Holistic Pain Management
Medical Marijuana
Pain Management
Palliative Care
Please select all services that this location offers.
Amenities Offered
(Required)
24-Hour Assistance/Care
Bathing and Showering Assistance
Beauty Salon / Barber Shop
Chapel
Clearly Marked and Alarmed Exits
Communal Garden and Courtyard
Dressing and Grooming Assistance
Emergency Call Systems
Entertainment
Fitness Center
Game Room
Handrails and Grab Bars
Housekeeping / Linen Service
Laundry Service
Library/Computers
Massage Therapists
Medication Management
Movie Theater
Organized Activities
Porches, Patios, and/or Sunrooms
Private Dining Rooms (for residents who want to entertain family and friends)
Professionally Prepared Meals
Special Meal Plan Options
Stair Lifts
Wheelchair Ramps
Wide Doorways
Zero-Threshold Showers
Please select all services that this location offers.
Any Other Services or Amenities Offered
(Required)
Please list all amenities offered.
Additional Business Attributes
(Required)
Veteran-Owned
Women-Owned
Wheelchair Accessible Entrance
Wheelchair Accessible Restrooms
Wheelchair Accessible Seating
None Of The Above
Please select all services that this location offers.
What are any other geographical references that people may use to describe the location of your business?
Who are your main competitors?
Primary Keywords / Phrases You Want Your Business To Rank For
Languages Spoke By Staff
(Required)
Please upload the following photos and logo files:
Exterior Photo of your building ( 1 or 2 photos )
Photos at/inside your location ( Try to have a picture of employees interacting with residents. 3-5 photos minimum. These photos will be online so you must have permission! )
Company logo ( Preferably .png or vector format and the larger the better - small logos don't work well )
Please upload business photos and logos
Drop files here or
Select files
Accepted file types: gif, jpg, jpeg, ai, eps, png, Max. file size: 512 MB.
gif, jpg, jpeg, ai, eps, png
Birdeye Account Setup
Birdeye Account Email
Do you want to have Birdeye automatically post reviews to your social media pages?
No
Yes, all 4 and 5 star reviews
Yes, only 5 star reviews
What format do you want Birdeye to send out review requests? (Asking residents or their families to leave a review)
SMS Only
Email Only
SMS & Email (Recommended)
