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.

Project Description*

The more detailed, the better.

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: 256 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: 256 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 Title*

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

New Physician Start Date:*

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

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

Upload CV/Bio Here:*

Max. file size: 256 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.

Upload Headshot Here*

Max. file size: 256 MB.

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 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)

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?

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

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: 256 MB.

Event/Temporary Signs

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

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