I make 100% original, custom Web sites, and also highly customized Wordpress sites.
I work in a Unix environment (OpenBSD) and hand-write the code for Web sites using vi, and draw the graphics using gimp.
When designing the look of a Web site, I try it to make it look interesting and well made. I enjoy making sites look artistic and unusual. I believe Web sites that look unconventional are good for many kinds of small businesses.
In some of the sites I've designed, I decided how it would look, and in others, I was given instructions or a drawing. When the customer gives me design instructions (describing how it should look as well as how pages should be structured) they can save up to 50% since I will spend about half the time working on it.
When communiating how a site should look, a very simple line drawing will do. Here's an example of a customer drawing.