Project Request Form
Please note: Do NOT submit PHI or PII through this form.
LHC Creative Request Form
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Contact Information
Who is the primary point of contact?
(Required)
Select one
Amanda L. Gustavson
Bryant Eaglin
Chris Broussard
Erin Batiste
Evelyn Foster
Kelly A. David
Patrika Cassie
Perla Rodriguez
Rachel Steward
Sarah Kracke
Tanzel J. Montgomery
Tiffany Segura
Your email
(Required)
Select one
Amanda.L.Gustavson@louisianahealthconnect.com
Bryant.Eaglin@louisianahealthconnect.com
Christopher.S.Broussard@louisianahealthconnect.com
Erin.Batiste@louisianahealthconnect.com
Evelyn.J.Foster@louisianahealthconnect.com
Kelly.A.David@louisianahealthconnect.com
Patrika.Cassie@louisianahealthconnect.com
Perla.Rodriguez@louisianahealthconnect.com
Rachel.Steward@louisianahealthconnect.com
sarah@sarahkracke.com
Tanzel.J.Montgomery@louisianahealthconnect.com
Tiffany.Segura@louisianahealthconnect.com
Are there any other contacts we should include on project-related communications? Select all that apply.
Amanda L. Gustavson, Amanda.L.Gustavson@louisianahealthconnect.com
Bryant Eaglin, Bryant.Eaglin@louisianahealthconnect.com
Chris Broussard, Christopher.S.Broussard@louisianahealthconnect.com
Erin Batiste, Erin.Batiste@louisianahealthconnect.com
Evelyn Foster, Evelyn.J.Foster@louisianahealthconnect.com
Kelly A. David, Kelly.A.David@louisianahealthconnect.com
Patrika Cassie, Patrika.Cassie@louisianahealthconnect.com
Perla Rodriguez, Perla.Rodriguez@louisianahealthconnect.com
Rachel Steward, Rachel.Steward@louisianahealthconnect.com
Sarah Kracke, sarah@sarahkracke.com
Tanzel J. Montgomery, Tanzel.J.Montgomery@louisianahealthconnect.com
Tiffany Segura, Tiffany.Segura@louisianahealthconnect.com
Project Details
Please share as much details as possible to help us best understand and process your request.
Project name
(Required)
Who is the primary audience?
(Required)
Member
Provider
Community/Public
Employee
Government
Other
Which organization is your creative request for? For multi-brand, select "Other" and specify the organizations.
(Required)
Louisiana Healthcare Connections
Ambetter Health
Wellcare
Other
First proof due date
(Required)
MM slash DD slash YYYY
Final file due date
(Required)
MM slash DD slash YYYY
This creative request is for
(Required)
A new project
An update or redesign of an existing project
An addition to a current project that already exists
Project Assets
Please upload any required assets to complete this job, if any. If this is an update to an existing project, please include the latest version. Other potential asset examples include creative brief, body copy, photo recommendations, creative inspiration, and language translations.
Drop files here or
Select files
Max. file size: 10 MB.
Deliverable Type
(Required)
Please select all that apply
Ad(s) – print
Ad(s) – digital
Banner
Brochure
Direct mail piece
E-mail header
Flyer
Folder notecards/envelopes
Icons
ID cards/carriers
MDC information sheets
Member forms
PDF editing/updating
Postcard/mailers
Retractable banner
Social media cover images: Facebook (820×360), LinkedIn (1128×191), Youtube (2560×1440)
Social media post
Swag or promotional item
Website banner images
Yard signs
Other
Specifications
Add
Remove
Please include dimensions for your deliverable, if applicable. If you have deliverables with different specifications, click the + button to provide the different specs.
Brief description of the project
(Required)
Please add any additional details that may help.
Will the final deliverable need to be designed in another language? If so, please select all that apply and ensure final, translated copy has been included in project assets.
Spanish
Vietnamese
First Name
Last Name
Phone Number
Email Address
Tell us how we can help.