Educational Materials Order Form for Healthcare Providers

To receive your free educational materials, please fill out and submit the form below.

Contact Information

Name(Required)

First Last

Organization/Practice Name

Specialty

County(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number

Email(Required)

Enter Email Confirm Email

Material Order

Quit Tobacco Today Cessation Brochure

Quit Tobacco Today Cessation Brochure

Quit Tobacco Today Cessation Brochure SPA

Quit Tobacco Today Cessation Brochure (Spanish)

Benefits of Quitting Poster

Benefits of Quitting Poster

Benefits of Quitting Poster (Spanish)

Benefits of Quitting Poster (Spanish)

Cessation Services Poster

Cessation Services Poster

Cessation Services Poster (Spanish)

Cessation Services Poster (Spanish)

Cessation Services Palm Card (English & Spanish)

Cessation Services Palm Card (English & Spanish)

Quit Tips Booklet

Quit Tips Booklet

Quit Tips Booklet (Spanish)

Quit Tips Booklet (Spanish)

Savings Calculator

Savings Calculator

Cessation Services RX Pads

Cessation Services RX Pads

Cessation Services RX Pads (Spanish)

Cessation Services RX Pads (Spanish)

Fax Referral Form

Fax Referral Form

Fax Referral Form (Spanish)

Fax Referral Form (Spanish)

Tobacco Free Florida’s AHEC Cessation Program will be in contact with you soon. The estimated turnaround time for materials is two weeks.