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VDH Arbovirus Materials Order Form
The Vermont Department of Health created educational materials that provide information about mosquito-borne and tick-borne disease prevention. All materials are free of charge. Please place your orders here.
1.
Please enter your information with the mailing address that we should ship to:
Organization/Practice Name:
Requested By:
Affiliation (Ex: Private Practice, Town Clerk, Town Health Officer, Vet, Other):
Mailing Address:
City/Town:
State:
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Email Address:
Phone Number:
2.
Date of Request:
Month/Day/Year
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Zika Travel Warning Poster for Pregnant Women
3.
Zika travel warning poster for pregnant women 2016
10
20
Other (please specify)
Zika travel warning poster for vacations
4.
Zika travel warning poster for vacations
10
20
Other (please specify)
Be Tick Smart: What you should know about tick bites and Lyme disease
5.
How many Tick booklets would you like to order?
25
50
75
100
Other (please specify)
Vermont Tick ID Card
6.
How many Tick Cards would you like to order?
25
50
75
100
Other (please specify)
7.
How do you plan to use these educational materials?
8.
Please let us know if there are other topics for patient education that would you like us to provide.
9.
Any questions? Please call the Epidemiology Field Unit at 800-640-4374 or 802-863-7240 or check the website at healthvermont.gov.
Please use the text box below to leave any comments. Thanks very much!
10.
How did you find out about these materials?
At a conference
From the Vermont Department of Health directly
On the Vermont Department of Health website
Facebook
From a friend or colleague
Other (please specify)
