Skip Navigation U.S. Department of Health and Human Services www.hhs.gov/
Agency for Healthcare Research Quality www.ahrq.gov
www.ahrq.gov/

AHRQ Publications Order Form

Ordered by

  
Name_______________________________________________________________________ Credentials_______________
  
Title_________________________________________________________________________________________________  

Organization_______________________________________________ Department________________________________

Address_______________________________________________________________________________________________  
  
City_________________________________________________________ State _________ ZIP ____________________  

Phone:    Office_______________________________________ Fax___________________________________________

E-mail Address_________________________________________________________________________________________

Ship to (if different than "ordered by")

  
Name_______________________________________________________________________ Credentials_______________
  
Title_________________________________________________________________________________________________  

Organization_______________________________________________ Department________________________________

Address_______________________________________________________________________________________________  
  
City_________________________________________________________ State _________ ZIP ____________________  

Phone:    Office_______________________________________ Fax___________________________________________

E-mail Address_________________________________________________________________________________________

Publication Number Free Copies Paid Copies Total Copies Price Each Total Cost
           
           
           
           
           
           
           
           
           

To order by phone:
800-358-9295 (toll free)

To order by E-mail:
AHRQPubs@ahrq.hhs.gov

Mail this form to:

AHRQ Publications Clearinghouse
PO Box 8547
Silver Spring, MD 20907-8547

Subtotal  
Discount (if applicable)  
Total  

Credit Card Type     MasterCard__________________________ Visa________________________

Card Holder's Full Name_______________________________________________________________

Credit Card Number_____________________________________ Expiration Date_______________

Please Note

For larger quantities or Purchase Orders, please call AHRQ Clearinghouse at 800-358-9295. Charges may apply for bulk quantities and for delivery to addresses outside of the United States.

____ Yes! Please send me Research Activities each month.

Return to Contents

 

AHRQAdvancing Excellence in Health Care