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Patient Information Leaflet Order Form
Type in the boxes next to the leaflet name, the number of copies of each you require. If you do not want any of the named leaflet, leave the box blank.
*
1.
Your details
(Required.)
Full name
Title
Organisation
Email address
Telephone number
*
2.
Full delivery address including ward number, clinic or department name, or store/goods in details (please be as clear as possible to avoid deliveries being refused and additional costs being incurred by the charity).
(Required.)
Address line 1
Address line 2
Address line 3
City or town
County
Postcode
3.
Please send me the following leaflets:
(If you require more than the permitted amounts, please contact us directly via helen@miscarriageuk.org).
1. Contact cards (max 250)
2. Supporting you through miscarriage (max 200)
3. Ectopic pregnancy (max 100)
4. Second Trimester Loss (max 100)
5. A4 Miscarriage UK poster (max 5)
