#PADPlanInAction Poster Mailer Form

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Fill out the form below to receive your printed copy from Newman Medical. Please allow up to 14 days for delivery.

Name of Practice

Type of Practice

Contact Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

If you would like a printed poster to display in your clinic, please let us know how many to send (limit 3 per clinic):

Would you like an electronic copy (PDF) of the PAD Awareness Poster sent to your email?

Would you like us to send patient brochures for PAD?