Form | PT Solutions Physical Therapy

Type

Who are you ordering cards/and or name tags for?*

Employee Status*

Start Date

Which do you need?*

Check all that apply.

Business Cards
Name Tag
Name Plate (Practice Support only)

Requester Name*

First Last

Full Name*

If you are a clinician, please include your credentials! ex: PT, DPT, OCS

First Last Credentials

Title*

PTS Email*

Business Card Information*

Please provide everything that should be on your business cards, including full name AND credentials (ex: PT, DPT, OCS). Please make sure all spellings and credentials are correct before submitting! To submit more than one individual's order, press the (+) to the right.

Name	Credentials	Title	Clinic	Cell Phone (if desired)	Email Address	Need Business Cards (Y/N)	Need Name Tag (Y/N)	Need Name Plate (Y/N) Practice Support Only

Cell Phone

If desired. This is not required.

Clinic Phone Number*

Clinic Fax Number*

Clinic Name*

Clinic Address:*

We will ship to this address unless otherwise noted.

Street Address Suite Number City State ZIP Code

Clothing Order

Uniforms are ordered on the 1st and the 15th of every month. Please allow time for ordering and shipping.

Who are you ordering for?*

Button Down Sizing*

You will receive 1 item for each day worked. Aide and PSC clothing is ordered on the 1st & 15th of each month. Please allow 3-4 weeks for delivery. To enter more than one individual's order, press the (+) to the right.

Employee Name	Clinic	Aide/PSC?	Days Per Week Worked?	Female/Male?	Size (XS-6XL)	# of Blue Button Downs	# of Pink Button Downs	# of Purple Button Downs	Nametag Needed? (Y/N)

Vests & Cardigans

PSCs Only - If ordering multiple pieces of one item, please put the quantity in parentheses. Example: (2) 2XL

Employee Name	Clinic	Female/Male Cut?	Vest Size (XS-6XL)	Female Cardigan Size (XS - 4XL)	Male Pullover Size (XS - 4XL)	Notes

Polo Sizing*

All clinicians who work events should have a PTS branded blue Under Armour polo. Polos are not to be worn in the clinics per PT Solutions dress code policies. To enter more than one individual's order, press the (+) to the right. If you have questions about event clothing, please reach out to marketing@ptsolutions.com.

Name	Clinician Type	Clinic	Male/Female?	Size (S-3XL)

*Disclaimer* Uniforms are ordered on the 1st and the 15th of every month. Please allow time for ordering and shipping.

Tell us more about this opportunity!

Please do not commit to any financial agreements until this request is reviewed by Marketing. Marketing will review the request and reach out if we have questions, need approvals from leadership, and/or confirmation of next steps.

Type of Request*

Date Needed by:*

Please allow 2 weeks turnaround for all marketing pieces.

Cost*

Link to more information/partner website

More Information*

Provide thorough information on this sponsorship. What does the sponsorship entail? Is it more passive (signs & banners) or will it be more active (clinicians on site). Please detail how this sponsorship will benefit both parties.

More information*

Please give us all the details you need included on this piece. If you have one already mocked up an example you can attach it below!

Details

Have a pdf that details the specs and requirements for this ad/flyer? Attach it below!

Drop files here or

*Disclaimer* Please do not agree to any financial commitments before submitting your request to Marketing. Marketing must be the final approver on all check requests for sponsorships and marketing requests.

Tell Us About Your Event!

Please enter events you are confirmed to attend with as much detail as possible. iCapture codes will be issued by email the week of your event from Hannah Mansfield.

Approval*

Due to COVID-19 precautions, all events must be approved by your DCO. Please do not submit a request, until approval has been confirmed by your leadership.

Yes, I have reviewed my event with my DCO and received approval to proceed.

Type of Event*

Event Details*

To add multiple events click the plus sign!

Full Event Name	Date	Event Website	Performing Screens? Y/N

State Event Takes Place*

What Florida Region are you in?*

Dig through the Marketing Closet!

Check all boxes that apply to your order. Please do not order extra items if it is not in your purview to order them. **Before submitting item & material orders please check with your physician liaison to see if they have the item on hand **

Clinic Print Material

All items below are custom ordered for the clinic listed below. To order business cards or name tags, please start a new marketing request.

Appointment cards
Letterhead
Envelopes (letter size)
Thank you cards + envelopes

Physician Marketing Materials

Referral Pads
YPR Pads
Outgoing Referral Pads (50 pages per pad)
Location/Insurance Pads
Direct Access Postcards (limited to certain states)
Injury Screen Cards (limited to those who don't see Direct Access)
New Clinic - Coming Soon/Now Open flyer bundle

4x9 Cards

Each set comes with 50 cards.

Need more than 50 4x9 cards? Let us know here!

Promotional Items

More information may be need after selections are made.

Baby Onesie
Box of 100 Patient Shirts ($500 - must have approval by SCD)
Specialty Order

How many onesies do you need?

Please enter a number less than or equal to 5.

Who will you be gifting this onesie to?*

We like to keep track of new babies in the PTS Fam & in our provider network! Please let us know who will be receiving this onesie.

Who should we ship to?*

Please let us know if you would like it wrapped and packaged for the parent to be to open or if you would like us to ship it directly to you so you can wrap and gift to the recipient.

Specialty Item Request

Tell us more about the items or materials you are looking to order and what they will be used for. Please note if you are ordering a specialty item it could take up to 8 weeks to design, create and ship.

Shipping Details

Clinic Name*

Clinic Address:*

Street Address Suite Number City State ZIP Code

Would you like this order shipped to the clinic listed above?*

Please note: we will not ship to home addresses due to cost.

Yes, please!
No, I'd like to ship somewhere else

What clinic would you like this order shipped to?*

Please note, we will not ship to a home address due to cost.

CAPTCHA

Please fill out the form below

Clothing Order

Tell us more about this opportunity!

Tell Us About Your Event!

Dig through the Marketing Closet!

Shipping Details