Use this form to request free resources for you and your patients – mailed free of charge.

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* 1. First name

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* 2. Last name

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* 3. Email address

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* 4. Mailing address

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* 5. Please identify yourself. I am a/an:

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* 6. Please select the English resources you would like mailed to you. Each resource is mailed in quantities of 25 unless otherwise noted. If you would like a different quantity, please specify the quantities for each resource in the comment box.

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* 7. Please select the French resources you would like mailed to you. Each resource is mailed in quantities of 25 unless otherwise noted. If you would like a different quantity, please specify the quantities for each resource in the comment box.

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* 8. “Caring for a child with food allergy” in additional languages. Please select which resources you would like mailed to you. Each resource is mailed in quantities of 10. If you would like a different quantity, please specify the quantities of each resource in the comment box.

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* 9. If you are interested in patient resources in languages other than those listed above, please specify which language(s) below so we can consider them for future translations.

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