Handbooks & Handouts Customization Form

Customized 5 Keys Handbooks & Handouts

Please complete the following form to customize your 5 Keys books & handouts.
Clinic Name*
Clinic Contact and Title*
Clinic Phone Number*

Area CodePhone Number
Clinic Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Clinic Billing Address (if different than mailing)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Clinic Website*
Email Address*
example@example.com
Upload Clinic Logo Here (high-resolution size)*

Browse Files

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How many books would you like to order?

100 books at $11.95 each300 books at $8.95 each500 books at $7.95 each1000+ books at $6.95 each
*Pricing above does not include $150 customization fee or shipping which is typically $30-$45 per box of 100 books, depending on your location
Example of custom first page:
For the custom first page (see example above) would you prefer to:

Use the standard custom paragraph aboveUse the standard custom paragraph, but with changes described belowUse your own paragraph pasted below (some clinics like to use their mission statement, etc.)
Please provide details related to your answer above.
Your contact information goes below your custom paragraph. Please select the contact information you would like included (check all that apply).

WebsitePhoneEmail AddressPhysical AddressOther
Patient handouts can be customized with your logo and contact information. Pricing depends on the quantity ordered (the more you buy, the less your per-handout cost is). Please make your selections below.

Note: There is an additional one-time $50 customization fee per handout. If you prefer to order non-custom handouts, please complete THIS FORM.
Patient Rack Card (introduces the 5 Keys)
Speaker Tip Handout (communication strategies for the speaker)
Listener Tip Handout (communication strategies for the listener)
Customized book and support material orders will be invoiced via email after we receive this form submission. Once payment has been received we will send you proofs via email for your approval. Upon approval of the proofs, the order will be sent to the printer where it takes 3-4 weeks for printing and delivery. Note that books and handouts will be delivered separately so there will be separate shipping charges for each product.
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