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MARKETING SERVICES REQUESTS
Contact Details
*
Indicates required field
Department/Division
*
Full Name
*
Today's Date
*
mm/dd/yyyy
Office Extension
*
Contact Email
*
Are you the primary contact for this request?
*
Yes
No
If no, please list name and info for primary contact.
*
Project Details
Please plan ahead. Your project request
may take up to 21 business days
to complete, from the date you submit your request. If your project needs to be printed by a third-party vendor, then a longer lead time will be required. If you are within a two (2) week window, please contact the Marketing Manager directly, prior to submitting this services request.
Name of Project
*
Estimated Project Due Date
*
mm/dd/yyyy
Project Description
*
Estimated total budget allocated for this project
*
What is your Estimated Project Quantity?
*
Please provide numerical values (123) or N/A if not applicable.
Project Specifications
Type of Projects
*
Event Program
Flyer / Poster
Brochure
Banner
Postcard
Invitation
Social Media (FB, Twitter, IG, etc.)
Note Card / Greeting Card
Email Blast / Email Communication
Display Sign / Yard Sign
Editorial / Written Content
Event Photography
Web-based Form
Press Release
Other
Purpose of Project
*
Project Requirements
*
Target Audience Profile
*
Current HRCHC patients
Potential HRCHC patients
All South Hampton Roads residents
Portsmouth residents only
Norfolk residents only
Chesapeake residents only
Suffolk residents only
Virginia Beach residents only
HRCHC staff
Media
Other
For Printed Projects Only: Does your project require dissemination to each of HRCHC’s clinical sites?
*
Yes
No
N/A
Have ideas you would like incorporated into the project? If so, please list below.
*
Need a digital component? Please List.
*
Includes QR Code, PDF, Fillable PDF, etc..
Project approved by department director or chief?
*
Yes
No
SIGNATURE *By typing your name in this field you are acknowledging that it serves as your legal signature on this document.
*
Date
*
If you have questions, contact Marketing @
[email protected]
or
757-397-0042
, ext. 587.
Submit
Home
About HRCHC
Our Story
Leadership
Board of Directors
A Letter From The CEO
A Letter From The CMO
Services
Service Locations
TeleHealth
Family Practice
Internal Medicine
>
Diabetic Care
Hypertension Information
OB/Gynecology
Pediatrics
Dental Care
Medication Assistance
Find a Provider
>
Medical
Dental
Pharmacy
>
Refills
Patient Services
New Patients
Patient Portal
HRCHC Community Partners
Success Stories
Book An Appointment Online
Human Resources
News & Events
NEWS
HRCHC EVENTS
Contact Us
Patient Complaint / Grievance Form
After Hours