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Med-South Materials Request Form
Med-South Materials Request Form
MedSouth Materials
Name
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Job Title
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Agency Name
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Address Line 2
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Is this agency a local or state health department?
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Which Med-South materials do you plan to use? (Select all that apply)
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Assessments
Educational Content
Cookbook
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With which group(s) will you use the Med-South materials? (choose all that apply)
*
Cardiac rehab patients
Research study participants
WISEWOMAN participants
Other
If you selected "other" above,, please specify.
How did you hear about the Med-South materials (formerly A New Leaf…Choices for Healthy Living)?
*
Journal Article
Conference or meeting
Other website
WISEWOMAN program
Cardiac rehab program
Other
If you selected "other" above, please specify.
User Agreement
*
We agree not to make any changes to the Med-South materials without express written permission in advance from the UNC Center for Health Promotion and Disease Prevention (HPDP). Our intent is to use these materials for educational and/or research purposes. We agree to include UNC copyright information when reproducing Med-South in the original or in an adapted form. Click the "I agree" button below to accept this agreement and show the files for downloading.
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