Healthy Heart Program
Stroke Publication Order Form
- The "Healthy Heart Stroke Publication Order Form" ia also availabe as a PDF.
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. |