Sponsorship Information Request

If you would like to be contacted by a business development executive for more information on sponsoring Healthy Advice Networks patient education programs for your brand, please complete the fields below.

If you are a physician, work as staff in a physician practice, or are affiliated with any other healthcare provider, please do not use this form: visit our Healthy Advice healthcare provider site.

Contact Information
Your Name
Your Email Address
Your Title
Your Company
Your Phone
Pharmaceutical or Consumer Health & Wellness Brand Information
Your (or your client's) brand category is:
I am most interested in sponsoring programs targeted to:	Primary Care Specialty Care
If specialty, please indicate which specialty(ies):
Services
I would like information on sponsoring patient education in: (check all that apply):	Waiting Room Network Exam Room Network PracticeWire®
I plan to include sponsorship of In-office programs in my planning for:	2011 2012 2013 Undecided
Please rank according to your importance (1-6)
Category Exclusivity
Measurable NRx lift
Educational content
Ability to customize
Integration with sales force
Targeting capabilities
Is targeting the Hispanic market important to your Brand's success?	Yes No
Other Comments
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