Order Form - Caries Prevention Material

Thank you for your interest in our educational material. They are designed to provide evidence-based mes-

sages about preventing childhood caries, and can be used to introduce key oral health messages to parents

and care-takers, as well as reinforce previous educational messages. We encourage using these in health cen-

ters, well-baby clinics, dental clinics, and with preschool programs, WIC, and Head Start centers.

To order your caries prevention material:

1. Section A: Mailing information— Fill in your contact information.

2. Section B: Magnets & DVDs— Enter the number of Magnets & DVDs you would like in the box next to

each option.

3. Section C: Poster Choices— Enter the quantity of each poster you would like (limit 5) in the box next to

each poster number.

4. Save the completed form and email it to: ahorowit@umd.edu.

Section A: Mailing information

Please enter the name and mailing address to send the posters to:

Name______________________________________________ Title ________________________________

Organization ____________________________________________________________________________

Address ________________________________________________________________________________

City __________________________ State ____ Zip ________

Email __________________________________ Phone ________________________________

Section B: Magnets & DVDs

Lift-the-Lip (Similar to Poster #8

Fluoride Prevent Cavities (Similar to Poster #6)

DVD: Healthy Mouths for You and Your Baby

DVD: Boca Sanas para Tí y Tu Bebé (Healthy Mouths for You and Your Baby with Spanish subtitles)

If you have difficulty using this form electronically, you may mail your order form to:

University of Maryland School of Public Health

Herschel S. Horowitz Center for Health Literacy

Oral Health Poster Order

2367 SPH Building #255

College Park, MD 20742

ENGLISH — Posters

SPANISH — Posters

Section C: Poster Choices

1 2 3 4

5 6 7 8

11 12 13 14

15 16 17 18