Materials request form

Materials request form

We can add your logo, address, and/or unique URL
What toolkit materials would you like to request?

ALL ITEMSALL SPANISH ITEMSPoster 01Poster 02Poster 03General Prevention Rack CardResponsible Opioid Use Rack CardTalking PointsFact SheetPrescribing Best Practices ChecklistWallet CardCampaign Overview GuideSpanish PosterSpanish General Prevention Rack CardSpanish Responsible Opioid Use Rack CardSpanish Talking PointsSpanish Fact SheetSpanish Prescribing Best Practices ChecklistSpanish Wallet CardSpanish Campaign Overview Guide
How many of each item would you like to request?
What, if any, toolkit items would you like to customize?

ALL ITEMSGeneral Prevention Rack CardPoster 01Talking PointsPoster 02Fact SheetPoster 03Campaign Overview GuideResponsible Opioid Use Rack CardPrescribing Best Practices ChecklistWallet Card
What customizations would you like us to make?*

Add your logoAdd your URLAdd the address of a nearby secure medication drop boxOther
Upload your logo (if applicable)

Add file type suggestions here.
Cancelof
Address we should send the materials to*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Describe what you might like to change or add to your toolkit items
Custom URL
Name*

First NameLast Name
Email Address*
example@example.com
Should be Empty: