Health Experts: Client Informational Form

Email Address*

Your Name*

First Last

Your Phone Number*

Ad Type*

Full Page Health Expert Profile
Full Page Ask the Expert
1/2 Page Health Expert Profile

Business/Practice/Doctor's Name*

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Phone Number(s)*

Website*

Please note: "www." will be removed for print.

Specialty*

To be displayed on ad tab. (i.e. Oral Surgery) 30 characters/space max

Top Doctors or Top Dentists: Years Awarded*

Please provide what year(s) you were awarded. (Up to 3 for a half page, up to 4 for a full page.)

Top Doctor or Top Dentist winner(s) names and associated years.

Health Expert Profile - Full Page*

*Please only fill out this field if you are running a full page health experts profile. Please provide one paragraph with information about your practice such as: Your specialties or featured products, your approach to care, your practice's history, your accreditations. 300 words max, please note that Philadelphia magazine will edit the content to adhere to section standards and the magazine's style guidelines.

Health Expert Profile - Half Page*

*Please only fill out this field if you are running a full page health experts profile. Please provide one paragraph with information about your practice such as: Your specialties or featured products, your approach to care, your practice's history, your accreditations. 80 words max, please note that Philadelphia magazine will edit the content to adhere to section standards and the magazine's style guidelines.

I need a photo taken.

If a photo is needed, please specify desired photography session date.

Desired photography session time.

:

I am supplying my own photo.

Upload here. Photo must be high-resolution, 300dpi at 100% of final print size.

Drop files here or

Accepted file types: jpg, png, jpeg, Max. file size: 99 MB.

Photo Use*

No, I do not want to receive the rights to one (1) photo. I understand that I do not own the rights to it and this photo may only be used for advertisement purposes within Metrocorp, INC branded publications.
Yes, I want to receive the rights to one (1) photo to use outside of Philadelphia magazine (additional fees apply).

I acknowledge my one-year contract includes one photo shoot and one photo per year for my ad placement (two for 2-page spread with profile), layout of my profile ad with three rounds of edits/revisions if needed. Ask the Expert advertorial also includes interview with 8-12 questions.*

Additional revisions will incur a $25.00 fee per revision. Additional photography will incur extra costs per session for photographer fee.

I agree to the terms above.