Preventive Care Patient Brochure Request Form

Team Up to Stay Healthy is a short information piece to help your patients understand the importance to receive preventive services and how to clarify when cost-sharing is waived.

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First Name
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Last Name
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Address
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Address Line 2
 
City
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State
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ZIP Code
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The Early Detection Saves Lives insert is also available in English and Spanish, in bundles of 50.  Please indicate how many bundles of 50 you would like for your office.

English
 
Spanish