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SBHC Asthma Project Ordering Form
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1.
Please provide your contact information:
(Required.)
Name
Name of SBHC
Email
Phone Number
SBHC Address
(Items will be shipped here)
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2.
Please select the items needed
(Required.)
Spacers (Medium)
Spacers with Mask
Water Bottles
(Student Incentive)
Pens
(Student Incentive)
Asthma Action Plans
Trigger Trackers
Know the Difference Between Your Asthma Medications Flyer
Talking to Teens about Tobacco Use and Vaping Brochure
Asthma Health: What Teens Need to Know Brochure
Controlling Asthma and Allergy Triggers at Home Brochure
American Lung Association Tobacco Cessation Resource Page
(Teen Programs)
"Let's Take Control of Asthma" Flipchart Pre/Post Survey
Other (please specify)
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3.
How many do you need?
(Required.)