campaign request form

You can submit a Campaign Request via our simple request form below.

Just let us know what you’re promoting, which types of patient customers it’s for and other campaign details. We'll do the rest!

Questions? Call us at 813-284-2000 -or- email us at: marketing@atlantic-hs.com

Please complete the form below:

Name

First Name

Last Name

Email Address

Just in case we have a follow-up question

Campaign Title:

What product or service do you want to promote?

Offer Details:

Audience Gender:

Kickoff Date:

MM

DD

YYYY

Campaign End Date:

MM

DD

YYYY

Total Ad Budget

$

Requested Digital Channels:

We'll make recommendations ourselves, but if you would like us to focus on any digital marketing channels in particular, feel free to tell us here:

Facebook

Instagram

Social Media (Other)

PPC

Blogging

Email Marketing

Other

Anything else we need to know?