Physician reference digest order form

Step 1 of 3: Complete order form

View our privacy policy. | * = Required fields.

Shipping information

First name *	Last name *
Organization (optional)
Street address * (Note: we cannot ship to PO BOXES)	Street address, line 2 (optional)
City *	State *	Zip code *
Email address *	Phone number * (Please do not enter anything but a phone number in this field (e.g. xxx-xxx-xxxx)

Your order

Quantity *
If you are requesting more than one copy, how/where will you distribute/use the others? * (Required only if ordering more than 1)
Would you like to receive an email reminder of updated or revised Heart Truth products? *

Validation code

Your validation code is: 38843 (What's this?)
Please copy your code into the field below.

Questions about this order form

Why do I need to supply my phone number?

We need your telephone number to contact you if your order is returned as damaged or otherwise undeliverable.

What is my validation code? What is it for?

The validation code is a random 5-digit number that is generated when you open the order form. You can copy and paste, or re-type the number in the validation code field. We use this to help reduce "form spamming," where automatic form fillers submit bogus requests by repeatedly submitting website forms. This helps us process your order more quickly.

I can't see the form. It says "Thank you for your request ... we can only take one per user."

This is by design. If you have already submitted a request, you will not be able to submit another one.

Content last updated April 1, 2008.

Return to top

womenshealth.gov
A federal government website managed by the Office on Women's Health in the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services.
200 Independence Avenue, S.W. • Washington, DC 20201