Digital Marketing Request Form

Campaign Elements

Please select the campaign format you wish to order (you can choose more than one).

Web Banner Ad 1

Web Banner Ad 2

Web Banner Ad 3

Web Banner Ad 4

Web Banner Ad 5

Web Banner Ad 6

Web Banner Ad 7

Web Banner Ad 8

Clinic Information



Digital Marketing Information

When would you like to have your banner/eletter sent? *


Clinic Content for Advertisement

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


PHONAK ARTWORK DISCLAIMER: All Materials sent by Phonak (the “Materials”) include certain intellectual property owned by Phonak Canada Limited or its affiliates (“Phonak”). Phonak shall hold all right, title, and interest in and to (1) all text, graphics or digital components of the Materials, (2) all layouts, logos, structures or arrangements or other components of any materials presented to you that comprises the Materials, (3) all literal and nonliteral expressions of ideas that operate, cause, create, direct, manipulate, access, or otherwise affect the content of the Materials, and (4) all copyrights, patents, trade secrets, and other intellectual or industrial property rights in the Materials or any component or characteristic thereof (collectively, the “Phonak Intellectual Property”). The Materials prepared by Phonak or are for limited purpose use and any materials or advertisements prepared by you using Phonak Intellectual Property shall be subject to the review and approval of Phonak (such materials or advertisements shall not be amended, altered or modified without the further approval). All Phonak Intellectual Property shall be used without alteration or modification of any kind whatsoever. Any unauthorized use of Phonak Intellectual Property is strictly prohibited.