DEPG Requests Practice Name*Departments Graphics Marketing Web Graphic RequestGraphic Request Types* Business Card Design Catfish Banner Flyer Social Media Business Card Design Verify with client if they want their business card to double as appointment card. (If so, the practice information will go on the front and the appointment information will go on back)Appointment info on back?*YesNoLogo Files Drop files here or Practice Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone*Fax NumberEmail* Website URL*Catfish BannerAdd verbatim text that will go on the banner:*Call To Action Text*Learn MoreCall TodayClick HereSchedule AppointmentFlyerSize*Trifold8.5X11 (letter size)4X9 (rack card)Logo Files Drop files here or Content*Select OptionClient ProvidedNeed To Create Content InternallyText content provided by client*Does the client want specific photos or images?*YesNoClient Photos / Images Drop files here or Does client want to use specific colors?*YesNoWhat color(s) would the client like to use?*Social MediaDescription and Content*Does the client want specific photos or images?*YesNoClient Photos / Images* Drop files here or Marketing RequestChannel* Bing Facebook Google Marketing Request Types* Add New Service / Special To Campaign Budget Change Create/Adjust Ad Copy Full Account Audit Pause Account Resume Account Resume AccountWhen Should The Account Be Resumed?*Pause AccountWhen Should The Account Be Paused?*Full Account AuditWhat is the client experiencing in their practice?*What type of service would they want to focus on?*Have they experienced a huge drop in calls?*YesNoWhen did they begin to experience the drop in calls?*Budget ChangeCurrent Budget*Budget Change Type*Select OptionIncreaseDecreaseIncrease Amount*Decrease Amount*New Total Budget*Add New Service / Special To CampaignDetails Of Service / SpecialUpload Marketing Material For Service / SpecialClick Here to view an example. Drop files here or Does A Page For This New Service / Special Exist On Site?*YesNoPage URL*Example: https://www.website.com/special.phpDoes This Page Also Contain Information About BOTH The Service AND Special?*YesNo, the special or service needs to be added to the pageNo, there is no accompanying special or serviceCreate/Adjust Ad CopyUpdated Details Of Service / SpecialUpload Updated Marketing Material For Service / SpecialClick Here to view an example. Drop files here or Web RequestWeb Request Types* Site Down / Page Broken Update Phone Number Update / Remove Lead Emails Change Hours Add Banner Add / Remove Staff Members Add Script / Widget General Edit Change HoursSunday*Closed or Hours OpenMonday*Closed or Hours OpenTuesday*Closed or Hours OpenWednesday*Closed or Hours OpenThursday*Closed or Hours OpenFriday*Closed or Hours OpenSaturday*Closed or Hours OpenSite Down / Page BrokenURL Of Broken Page*ScreenshootPlease include screenshot of broken pageUpdate / Remove Lead Email AddressesEmail Addresses To REMOVE Email Addresses To ADD Update Phone NumberEXISTING Phone Number*UPDATED Phone Number*Add BannerBanner Content*Graphics For Banner Drop files here or Add / Remove Staff MembersAction* Add New Member(s) Remove Member(s) Members To REMOVE* Members To ADD* Input Type*Select OptionEnter Bios ManuallyUpload WordDocNo Bio or Bio Coming SoonBio(s)Bios Drop files here or PhotosPlease make sure the file names match the member name or the bio states which photo is who. Drop files here or Add Script / WidgetDescription Of Script / Widget*Code Placement*Where On The Site The Code Should Be PlacedSelect OptionAppointment ButtonsOnly Home PageFinance PageOther / Multiple PagesOpening Head and Opening Body (GTM Script)Header (All Pages)Footer (All Pages)I'm Not SureSpecific Page(s)*Please list the page URL(s) that you would like your script to appear on.Input Type*Select OptionEnter Code ManuallyUpload Plain Text FileScript / Widget Code*Upload Plain Text Files of Script(s) / Widget(s)* Drop files here or General EditPage(s) / URL(s) Where The Edit Needs To Be Made*Example: https://www.website.com/services.phpDescription Of What Needs To Be Changed*Files Needed To Complete Edit Drop files here or NotesPlease supply any notes you feel that would help elaborate on your request. Requester InformationName* First Last Email*
