You can always press Enter⏎ to continue
Marketing Request Form
1
Name
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
3
Facility
*
This field is required.
Please differentiate in the request if it is for your MAIN facility and/or promoting a CHANGES location.
Beckett Springs
Brentwood Springs
Carrollton Springs
Collin Springs
Columbus Springs
Columbus Springs East
Copper Springs
Copper Springs East
Cottonwood Springs
Denver Springs
El Dorado Springs
Help for Heroes
Highland Springs
Lifepoint Behavioral Health (HSC)
Mercy Health BH
Mesa Springs
Oakwood Springs
Rainier Springs
Rock Springs
Sycamore Springs
Tampa General BH
Triangle Springs
Valley Springs
WellBridge Fort Worth
Westpark Springs
Woodland Springs
Other
Previous
Next
Submit
Press
Enter
4
Has this request received the appropriate internal approval?
*
This field is required.
Please obtain approval from AVP of Business Development prior to submission.
YES
NO
Previous
Next
Submit
Press
Enter
5
Request Type
*
This field is required.
Brochure
Card/Mailer
Update Existing Print Collateral
Flyer
Print Ad
Rack Card
Social Post
Business Card - Special Order (Check Vivid First for an Existing Template)
Constant Contact Email Template
Vinyl Banner/Poster
Other
Previous
Next
Submit
Press
Enter
6
In-Hand Date Needed
*
This field is required.
/
Date
Month
Day
Year
Previous
Next
Submit
Press
Enter
7
Flyer
Please Select
Yes
No
Please Select
Please Select
Yes
No
Do you need this to be printed?
Target Audience
Objective / Message / Call to Action
Additional information or instructions that would be helpful for the designer
Previous
Next
Submit
Press
Enter
8
Rack Card
Target Audience
Objective / Message / Call to Action
Additional information or instructions that would be helpful for the designer.
Previous
Next
Submit
Press
Enter
9
Card/Mailer
What type of card do you want?
Target Audience
Objective / Message / Call to Action
Additional information or instructions that would be helpful for the designer.
Please provide size/specs.
Previous
Next
Submit
Press
Enter
10
Vinyl Banner/Poster
Width (inches)
Height (inches)
Objective / Message / Call to Action
Additional information or instructions that would be helpful for the designer.
Previous
Next
Submit
Press
Enter
11
Brochure
*
This field is required.
The preferred audience for a brochure is consumers/patients/family members. Please keep this in mind when requesting this piece and provide all relevant information. Additional information or instructions that would be helpful for the designer must be included. Please give as much detail as you can so that we can complete the piece in a timely fashion.
Previous
Next
Submit
Press
Enter
12
Update Existing Print Collateral
*
This field is required.
Please include ALL
Item ID#'s (
found in the lower right corner of the existing document and SPECIFIC DETAILS of all update(s) needed. If you cannot find ID# please upload a screenshot or digital version to this form below. Please include any additional information or instructions that would be helpful for the designer.
Previous
Next
Submit
Press
Enter
13
Social Post
Facebook
LinkedIN
Please Select
Facebook
LinkedIN
Select platform(s)
Target Audience
Objective / Message / Call to Action
Additional information or instructions that would be helpful for the designer.
Previous
Next
Submit
Press
Enter
14
Print Ad
Width
Height
Please Select
B & W
Color
Please Select
Please Select
B & W
Color
Color
Target Audience
Ad Placement (Directory, magazine, etc.)
Objective / Message / Call to Action
Additional information or instructions that would be helpful for the designer.
Previous
Next
Submit
Press
Enter
15
Constant Contact Email Template
*
This field is required.
Please provide as much detail as possible. You can upload your CEU schedule or other supporting files on the next page.
Previous
Next
Submit
Press
Enter
16
Business Card - Special Order (Check Vivid First for Existing Template)
*
This field is required.
Provide business card details, as well as the "Ship To" address if different than business card address. Please include any additional information or instructions that would be helpful for the designer
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
17
Other
*
This field is required.
Please provide as much detail as possible. You will have the option to upload supporting files on the next page.
Previous
Next
Submit
Press
Enter
18
Print Quantity
If applicable
Previous
Next
Submit
Press
Enter
19
File Upload
Please include any supporting documentation needed to complete your request.
Drag and drop files here
Select files to upload
Browse Files
Cancel
of
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
19
See All
Go Back
Submit