Healthy Heart Program

Stroke Publication Order Form

Quantities of the publications listed on this sheet are available free of charge to New York State organizations. To place an order, please circle the quantity desired and fill out the requestor information below. Forms may be faxed, mailed or e-mailed as specified below.

  • Fax: 518-465-0432
  • Mail: NYS Dept. of Health, Distribution Center, 21 Simmons Lane, Menands, NY 12204
  • E-mail: B0019W@health.state.ny.us

Requestor Information

Name:
______________________________________________________________________
Organization:
______________________________________________________________________
Address:
______________________________________________________________________
City, State, Zip Code:
______________________________________________________________________
Telephone Number:
(_______)______________________________________________________________
Date:
______________________________________________________________________
Describe how you will use the material.
______________________________________________________________________

Please Circle the Desired Quantity

Title Code Number Circle Quantity
Stroke Table Tents 1621 25 50 100 200*
Stroke Flyer/Brochure 1622 25 50 100 200*
Stroke Magnets 1623 25 50 100 200*
*For quantities greater than 200 please contact the Healthy Heart Program at hhp@state.health.ny.us , or by phone (518) 474-6683.