Please fill out this form for any marketing requests. Full name of person filling out this form:(Required)What department is this material for?(Required) Admin Dental Financial Counselors Medical Mental Health OB/Women's Health Pharmacy Population Health Vision OtroThis marketing material is:(Required) A reprint or reorder A reprint or reorder BUT with some changes A new marketing project request OtroThe Marketing material requested: Business Card English Patient Birthday Cards Spanish Patient Birthday Cards Birth Certificate Sheets OB Route Slips English Pop Health Postcards Spanish Pop Health Postcards OtroThe changes I need are:I need this marketing material:(Required) ASAP By a certain date Soonest marketing can get it to me No rush OtroDate needed by: MM slash DD slash YYYY Quantity needed:(Required) Exact Number Listed Below Marketing Department Decision OtroQuantity:Where will the materials be used?(Required) Admin Community Department Outreach Exam Room Screens Break Room Screen Waiting Room Screen Social Media Wall Posters OtroAll info for marketing material:Please include all text and info! The more info included the faster marketing can get your materials completed! CONTACTPROMISE COMMUNITY HEALTH CENTER CALL PROMISE SET UP AN APPT EMAIL PROMISE