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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.

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* 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:

ZIP:

Email Address:

Phone Number:

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* 2. Date of Request:

Month/Day/Year

Date

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Zika Travel Warning Poster for Pregnant Women

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* 3. Zika travel warning poster for pregnant women 2016

Other (please specify)

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Zika travel warning poster for vacations

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* 4. Zika travel warning poster for vacations

Other (please specify)

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Be Tick Smart: What you should know about tick bites and Lyme disease

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* 5. How many Tick booklets would you like to order?

100

Other (please specify)

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Vermont Tick ID Card

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* 6. How many Tick Cards would you like to order?

100

Other (please specify)

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* 7. How do you plan to use these educational materials?

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* 8. Please let us know if there are other topics for patient education that would you like us to provide.

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* 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!

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* 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)

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* 1. Please enter your information with the mailing address that we should ship to:

Question Title

* 2. Date of Request:

Question Title

Zika Travel Warning Poster for Pregnant Women

Question Title

* 3. Zika travel warning poster for pregnant women 2016

Question Title

Zika travel warning poster for vacations

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* 4. Zika travel warning poster for vacations

Question Title

Be Tick Smart: What you should know about tick bites and Lyme disease

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* 5. How many Tick booklets would you like to order?

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Vermont Tick ID Card

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* 6. How many Tick Cards would you like to order?

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* 7. How do you plan to use these educational materials?

Question Title

* 8. Please let us know if there are other topics for patient education that would you like us to provide.

Question Title

* 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!

Question Title

* 10. How did you find out about these materials?

* 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!