Department of Health
Department of Health
PUBLICATION REQUEST FORM
The New York State Department of Health offers limited quantities of free educational materials to New York State residents and organizations.
? No more than 10 different publications may be ordered.
? You may order up to 200 copies of each (10 copies of posters) or provide details on why more are needed.
? For fastest delivery, please list items in numerical order by code number. These orders will be processed first.
? Bulk orders cannot be delivered to post office box numbers.
Complete and email this form to OGS.SM.GDC@OGS.
PUBLICATION TITLE 1.
PUBLICATION NUMBER
LANGUAGE
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QUANTITY
NAME ORGANIZATION (IF APPLICABLE) STREET ADDRESS CITY, STATE, ZIP CODE PHONE NUMBER
MAILING INFORMATION
DATE
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