Order form - English



Hepatitis C Education Resources for Patients and ProvidersOrder FormHepatitis C Education Resources for Patients and Providers are available in print & memory stick formats. To order, complete the form below. Supplies are limited. Resources are available for download at bccdc.ca (type “Attendance project” in the search box for details).Please check all that apply and fill in quantity needed: FORMCHECKBOX FORMTEXT ?????complete pkg(s) of resources. Includes 1 copy of print resources (French & English), & memory stick (with: Hepatitis C: The Basics interactive course, PDFs of print resources, & videos) FORMCHECKBOX FORMTEXT ?????memory stick(s) containing: Hepatitis C: The Basics interactive course, PDFs of print resources, & videos FORMCHECKBOX # EnglishMail additional printed copies of the following resources # FrenchQuestions people frequently ask their providers about hepatitis CTests used for diagnosing hepatitis C (patient page)Hepatitis C virus pre- and post-test checklists (provider page)Frequently asked questions about hepatitis C (patient booklet)Frequently asked questions list (card)Getting ready for treatment (patient booklet)Patient “Bill of Rights” tip cardTips for Getting your Message Heard FORMCHECKBOX E-mail electronic copies of the print resources FORMCHECKBOX French only FORMCHECKBOX English only FORMCHECKBOX English & French versionsFull name (please print) FORMTEXT ?????Name of organization (if applicable)Street address FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????City/Town ProvincePostal Code FORMTEXT ?????E-mailAllow a minimum of 10 days for deliveryPlease return this form to Liza McGuinness, Project Coordinator, by email liza.mcguinness@bccdc.ca,Fax (604-707-2420) or mail to: Liza McGuinness / BCCDC / 655 West 12th Ave / Vancouver, BC / V5Z 4R4 ................
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