Enhanced Listing Web Form - Charleston Physicians

Thank you for selecting HealthLinks Charleston/HealthLinks Upstate to help brand and grow your practice.
Please complete this form so we can create your enhanced listing on CharlestonPhysicians.com or UpstatePhysiciansSC.com!

Required fields below are indicated by *

Region

Choose One*

HealthLinks Charleston

HealthLinks Upstate

CONTACT INFO

Your Name*

Your Email*

Email address to use for appointment requests sent from our website.*

HealthLinks Sales Rep*

ENHANCED LISTING INFO

Business Name*

Business Phone*

Choose medical specialty from the list below that is most applicable to your practice. If more than one applies choose the best option.*

Please write a description about your practice below, or put a web address where a description can be found.*

What is your website address?*

Up to ten patient testimonials about your business. (Submissions beyond 10 will not be used)

Please list all insurances you accept below.*

Provider Bios: 100 words or less for each provider.*

Provider Headshots
Max File Size Allowed Per File: 10.00 MB
Allowed File Types Are: GIF, JPG, JPEG, PNG, PDF, DOC, DOCX, RTF and TXT

Upload Provider Headshots

PRACTICE ADDRESS(ES)

Street address, city, state, zip code and phone number for your locations.

ATTACH FILE(S)

Logos, Office & Practice Photos
Max File Size Allowed Per File: 10.00 MB
Allowed File Types Are: GIF, JPG, JPEG, PNG, PDF, DOC, DOCX, RTF and TXT

Upload up to 10 files.

OTHER

Anything Else?

If you need to add anything else add it here. This is the perfect spot to add the web address for any images to use from your website.

This field should be left blank