Advertorial Request Form

Please Note that in order to fulfill all of our client marketing requests we require a minimum of 10 working days’ notice prior to the AD deadline. If your AD is due in less than 10 working days, please contact your Regional Sales Manager prior to submitting your request.

Campaign Elements

Please select the campaign format you wish to order.


BtC Coop Virto B-Titanium

Clinic Information

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Ad Information

Have you booked an AD space in your publication?
YesNo *
If yes, when is the deadline to submit the AD to your publication?
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Please provide your AD dimensions (in inches) as per your booking.
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Please provide the name of your publication?
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Clinic Content for Advertisement

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Please upload your logo if you would like it included in the ad:
Would you like to include a map?
YesNo *
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