Marketing Campaigns

Jotform Name
Enter the name(s) of any corporate group that the practice belongs to if applicable (you may enter multiple).
This form is intended to be filled out by the practice. Do you work for the practice?
Please enter your marketing partner referral code(s).
You may enter multiple. Don't key 'enter'.
Please provide your practice's Preventive Care Plans URL for pet owner enrollment into your practice's program.
If unknown, please type 'Not yet provided'
Scheduled go-live date for Preventive Pet Plans

MonthDayYear
Insert the date that you will be launching your Premier Pet Plans at your hospital.
Is your practice actively using the AllyDVM Communications platform?
Select your campaign(s)

______________________________________________________________________________________________

Checked = enroll Unchecked = do not enroll
Select all that apply:
How do you schedule a routine dental procedure within your practice management system appointment calendar? (This could be a specific appointment type, column, or keyword within the appointment notes)
The Pre, Day of, and Post dental campaigns are triggered to send before or after a dental procedure. To ensure the campaigns are sent accurately we must be able to identify specifically how these types of appointments are scheduled.
Pumpkin Pet Insurance
Please select either Preventative Essentials OR Pumpkin Wellness Club campaign selections below.
Pumpkin Preventative Essentials
Pumpkin Wellness Club
Pumpkin Final selected values
Pumpkin Hidden
VetOne Hidden
Pumpkin Selected Values
VetOne Selected Values
Warning! Campaigns for both Preventative Essentials and Pumpkin Wellness Club have been selected. Please choose only one set of campaigns to proceed.
Are there any Client Classes that you would like to exclude from receiving the 'Introduction of Pumpkin to Pet Owner' email?
How do you schedule an Annual Wellness appointment within your practice management system appointment calendar? (This could be a specific appointment type, column, or keyword within the appointment notes)
Wellness campaigns are triggered to send before or after an Annual Wellness exam and to ensure the communications are sent accurately we must be able to specifically identify how these types of appointments are scheduled.
Do you currently offer a custom Preventive Essentials Pack with Pumpkin?

Is ALLYDVM currently installed on your server?
Are you currently using AllyDVM's communication platform in your practice?
TVC Owner Number
VMG Group Number
Practice Name
Deal Stage
Deal Name
AllyConnect ID
AllyConnect ID can be located in your account at https://connect.allydvm.com within Gearwheel > Practice Profile.
Practice/Front Desk Phone
Format: (000) 000-0000.
Practice Email
Practice Website
Enter your website url. If you don't have one, enter www.none.com.
Practice Address

Street Address

Street Address Line 2

CityState /Region/Province

Postal / Zip Code
Country
Country
US States
State /Region/Province
Canadian States
State /Region/Province
Practice Address State Selected
Practice Management System
Please note, if your PIMS is not listed, you are not eligible to use ALLYDVM.
Practice Online Pharmacy
Practice Logo

Cancelof
Practice Contact Person
First and Last name only
Contact Person's Email
Contact Person's Phone Number
Format: (000) 000-0000.
Pumpkin Rep Name
Pumpkin Rep Email Address

MWI Account Number
Please locate your current MWI Account Number if applicable
Name of Your MWI Territory Manager
First and Last Name Only
Premier Rep Email Address
Name of Your AllyDVM Rep(s)
How did you hear about our program?
Other:
tell us how you heard about this program...
Agree to Terms

_________________________________________________________________________________________
Name of Order Form Submitter
This form must be submitted by an authorized decision-maker of the practice.
Signature

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Today's Date

MonthDayYear
MM/DD/YYYY
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