Fall Prevention Materials Reorder Form

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Connecticut Collaboration for Fall Prevention

Printed Materials FOR PURCHASE

The printed materials can be ordered by completing the form below and clicking on the submit button. Remember to fill in the quantity of the item(s) requested along with the appropriate contact information. A member of our team will send you an invoice for the requested materials. Please go to Description of Materials for Purchase for a description of the content of these materials.

*Please Note: We do not accept credit, debit cards or purchase orders.*

***SHIPPING & HANDLING***

DOMESTIC ORDERS (within continental U.S.): Shipping and handling is included.

OUTSIDE CONTINENTAL U.S., INTERNATIONAL AND/OR CANADA ORDERS: Shipping will be an additional charge shown on invoice.

Upon Receipt of your order, an invoice will be emailed or mailed. Materials will be shipped upon receipt of U.S. check or money order made payable to: “ Yale University – Falls”.

Starter Kit	Passbook	Trifold Brochure

Order Quantity $260.00 ea.	Order Quantity pkg(s) Pkg. 100 = $55.00	Order Quantity pkg(s) Pkg. 100 = $45.00

Medication Brochure	Postural Hypotension Brochure	Clinician Workbook *A Guide For Clinicians*

Order Quantity pkg(s) Pkg. 100 = $45.00	Order Quantity pkg(s) Pkg. 100 = $45.00	Order Quantity $70.00 ea.

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Any information you provide on this form will not be shared with any other organizations and will be kept confidential.

The work of the Connecticut Collaboration for Fall Prevention is funded by the Patrick and Catherine Weldon Donaghue Medical Research Foundation.