Application

Once you have selected your plan, please fill out the intake form below so we can set up your listing page. Please provide 5-7 business days for processing. Payment must be received before any listing page is processed. Listing pages remain active as long as your membership does.

Please enable JavaScript in your browser to complete this form.

Full Name *

Name of Company *

Location (City, State, Country) *

Company Address *

Email Address *

Phone Number *

Website URL *

Social Media Links *

example: https://twitter.com/gamactica

Categories *

• Surgeons
• Specialists
• Doctors
• Insurance Broker
• Insurance Agent
• Hospital
• Company
• Plastic Surgeon
• Dentist
• Veterinarian
• Mental Health
• Rehabilitation
• Other

About Your Business *

Are You Interested in Exploring a Partnership with Gamactica (DocsDock) for discount listings for your team? *

• Yes
• No

we will reach out accordingly

Do You Need a Website? *

• Yes
• No
• Maybe

Are You Interested in SEO/Internet Marketing Services? *

• Yes
• No
• Yes, But Not at this time

prices start at $1,000/month

Are You Interested in Advertising on Our Media/Content Outlets, Disko.TV *

• Yes
• No
• Maybe

Submit