HealthWire Partnership Form

Name (First & Last) *

Email *

Company Name *

Agency (Optional)

Partner Objective *
Paid AdvertisingMarketing / Co-Brand PartnershipTalent RequestOther Business Opportunity

If interested in Paid Advertising, what is your budget range?
$500,000 or more$250,000 - $500,000$100,000 - $250,000$50,000 - $100,000$25,000 - $50,000$10,000 - $25,000$5,000 - $10,000$1,000 - $5,000

Vertical
Medicare SupplementLife InsuranceHealth InsuranceWelnessNutritionFitnessSleepOther:

What are your campaign objectives, messaging strategies, and media KPIs?*

Are there any other specifics that we should know?