Marketing Request Form

Marketing Information

Provide as much detail as possible.

Project Name*

Requested Due Date*

*Production time may vary for orders – ALL projects must have 15 business day minimum notice before deadline.

What Creative Items Are Needed?*

Project Description*

The more detailed, the better.

Target Audience*

Potential Patients/Customers

Current Patients/Customers

Providers/Medical/Clinical Staff

Community Partners/Businesses/Organizations

Singing River Employees

Please Add Any Copy or Information to be Included*

Upload Documents Here

Please upload any relevant files to be used with your project request.

Drop files here or

Max. file size: 50 MB.

Update to Current Item(s)

Describe updates needed*

List Items needing updating*

How Can We Find Items to be Updated?*

Previous Marketing Request Form Project ID:*

This can be found in the confirmation email you received when you submitted the original Marketing request,

Upload Item(s) to be updated*

Drop files here or

Max. file size: 50 MB.

Email Graphic

Who should receive this email?*

Who will be sending the email out?*

Preferred E-mail Date*

Please select the date you’d like the email sent.

Please include anything that needs to be in the email graphic or linked within the email.*

New Physician Checklist Items

Please note – we cannot begin work on any New Physician Checklist Items until we have both a CV/bio and headshot in hand.

New Physician Name*

Please include all credentials needed in the Suffix field (i.e. MD or MD, FACS, etc.) as the physician needs to be listed externally.

First Middle Last Suffix

New Physician Title*

Please include as it should be listed. Ex: “Orthopedist”, “Medical Oncologist, Hematologist”, “Family Medicine Physician”, etc.

New Physician Start Date:*

Singing River employed physician?*

Yes

Other

Referral Needed?*

Please indicate if you need a referral to see this physician, or if there are special circumstances, choose other and further explain.

Yes

Other

What Location(s) Will The New Physician Serve?*

If a new office, please list address & contact info.

Upload CV/Bio Here:*

Max. file size: 50 MB.

How are we securing headshot?*

If you select “Need to schedule a headshot with marketing,” an automatic email will be sent to our marketing team and we will follow up to get details and schedule. Please note: collateral and website additions cannot be started without headshot in hand.

Preferred Headshot Location*

Ocean Springs Hospital

Pascagoula Hospital

Singing River Gulfport

Upload Headshot Here*

Max. file size: 50 MB.

New Physician Items Needed:*

Please indicate all items needed for this new physician

Welcome Social Post

New Faces Listing on Bridge

Welcome email to all users

Listing on External Website

Rack Card

Other…

Welcome Social Post / New Faces Listing on Bridge/Welcome email Preferred Date:*

External Website Deadline*

Rack Card Quantity*

Please enter a number greater than or equal to 0.

Rack Card Deadline*

Please indicate the date we need rack cards in-hand.

"Other" Items/Needs Details*

Please list and explain any “other” items needed for this New Physician

"Other" Items Deadline*

Flyer/Brochure/Rackcard

Quantity*

Please enter a number greater than or equal to 0.

How will these be displayed/distributed?*

Event Invitation/Materials

Event Date*

Event Start Time*

Event End Time*

Event Location Name*

Please Enter as you would like listed on invitations and event materials, including any room/suite numbers or location specifics (ex: Pascagoula Hospital – MSCR)

Event Location*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do attendees need to RSVP?*

Yes

RSVP Contact Name & Information*

Who is the RSVP contact and how should people contact them? (include phone number and/or email address, etc. for RSVP info)

Event Details*

What is the event? What is it for? Who will be there? What are the key takeaways?

Do you need an email graphic for this event?*

Yes

Who will be sending the email out?*

Preferred E-mail Date*

Please select the date you’d like the email sent.

Promo Items/Giveaways

Promo Item Type*

Budget per item*

Please enter a number greater than or equal to 0.

Who Will These Be Given To?*

Quantity*

Permanent Signs

Permanent Sign Type*

Laminated or Insert

Foamboard

Decal- Interior Wall

Window Decal

Banner

Other

Size of Permanent Sign*

Where Will Permanent Sign Be Placed?*

Permanent Sign Verbiage*

*Subject to Marketing Approval

Upload Permanent Sign Files Here

Drop files here or

Max. file size: 50 MB.

Event/Temporary Signs

Event/Temporary Sign Type*

Foamboard

Decal- Interior Wall

Window Decal

Banner

Pop-Up Display

Standee

Other

Size of Sign*

Where Will Sign Be Placed?*

Event/Temporary Sign Verbiage*

*Subject to Marketing Approval

Sign Details*

Please include any required graphics, logos, or other information needed on the sign.

Website Update

Type of Update*

New Page

Change On Current Page

Other

Describe Changes/Updates/Additions Needed*

Link to Page needing updates*

Video Projects/Production

Describe your video concept.*

What is the video about? Where is it shot? Who needs to be in it?

Is there a desired location for this production?*

Is there a desired shoot date/time?*

How long do you want your video to be?*

30 sec, 60 sec, 5 min, long-form, etc.

What is your video's objective?*

Describe your video's target audience.*

Is this for patients? Providers? Family Members? Who specifically do you want to talk to?

What do you want people to take away from this video?*

Do we need approval from a supervisor or interested party before we begin production?*

If so, who?

Who will be involved with the video production?*

How do you plan to distribute your video?*

Website, social media, tv, in-office, etc.?

When do you want to run/distribute your video?*

Before You Submit

Please note: You should receive a confirmation email containing all submitted information as well as a Project ID #.

Please save this email for your records, as we may need to follow up and reference this Project ID#.

If you do NOT receive a confirmation email, the form submission has NOT gone through and you will need to re-submit.

*Production time may vary for orders – ALL projects must have 15 business day minimum notice before deadline.

Contact Information

Marketing Information

Update to Current Item(s)

Email Graphic

New Physician Checklist Items

Flyer/Brochure/Rackcard

Event Invitation/Materials

Promo Items/Giveaways

Permanent Signs

Event/Temporary Signs

Website Update

Video Projects/Production

Before You Submit