Fillable MATERIALS ORDER FORM FOR TICK-BORNE & MOSQUITO-BORNE DISEASE (New York)

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MATERIALS ORDER FORM FOR TICK-BORNE & MOSQUITO-BORNE DISEASE (New York)

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MATERIALS ORDER FORM FOR TICK-BORNE & MOSQUITO-BORNE DISEASE
The New York State Department of Health offers limited quantities of free tick-borne and mosquito-borne disease
educational materials to New York State (NYS) residents and organizations.
To order, complete this form and submit it by mail or email to:
• Mailing address:
NYS DOH Distribution Center
OGS Consolidation Warehouse
PO Box 343
Guilderland, NY 12084
• Email address: OGS.SM.GDC@OGS.NY.GOV
• Email over maximum quantity requests to: bcdc@health.ny.gov
Please allow 2 to 3 weeks for delivery. Last Update 9/23/19
--------------------------------------------------------------------------------------------------------------------------------------------------------
ITEM # TITLE (and language if other than English) TYPE QUANTITY
(Circle) (Circle)
Tick-borne Disease Materials:
2811 How to Safely Remove a Tick* (2” x 5”) Card 1 10 50 100
2810 All About Ticks: A Workbook for Kids & Their Parents Book 1 10 50 100 200 300
2812 New York State Tick ID Card
(2” x 3½”) Palm Card 1 10 50 100
2813 Ticks & Lyme Disease Brochure* Brochure 1 10 50 100 200
PP12 Warning – Ticks in the Area May Cause Lyme Metal Sign 1 10
Mosquito-borne Disease Materials:
2731 Mosquitoes & Disease* Brochure 1 10 50 100 150 200
2732 Mosquitoes & Diseases (Spanish)* Brochure 1 10 50 100 200 300
Environmental Control
2750 What Do I Do if There is Spraying in My Community? Fact sheet 1 10 50 100 200 300
West Nile Virus (WNV)
2747 WNV: Do Mosquitoes Love Your Home and Yard? Fact sheet 1 10 50 100 200 300
2742 WNV Information for Outdoor Workers Fact sheet 1 10 50 100 200 300
2751 WNV: Senior Citizens Fact sheet 1 10 50 100 200 300
2748 WNV: Suggested Community Activities Fact sheet 1 10 50 100 200 300
Zika Virus
13036 Zika: Pregnancy Travel Advisory (11”x17”) Poster 1 10 50 100 200 300
13037 Zika: Pregnancy Travel Advisory (11”x17”, Spanish) Poster 1 10 50 100 200 300
Mosquito & Tick-borne Materials:
2714 Protect Yourself Against Mosquito & Tick Bites (Eng/Spanish) Flyer 1 10 50 100 200
2761 Protect Yourself Against Mosquito & Tick Bites
*(11”x17”) Poster 1 10 50
2816 Protect Yourself Against Mosquito & Tick Bites (Spanish) Flyer 1 10 50 100
2817
Protect Yourself Against Mosquito & Tick Bites (11”x17”, Spanish) Poster 1 10 50
2765 Tick & Insect Repellent: Deciding on their Use (Spanish)
* Brochure 1 10 50 100 200 300
*
Click title to view and/or print material
Please complete legibly. Illegible or incomplete information will affect the ability to send your
requested materials.
Requestor’s Name:
Organization:
Street Address:
(Note: no delivery to Post Office Boxes)
City/State/Zip:
Telephone Number:
Email Address:
Date of order:
URLs for Digital Versions of Print Materials:
• How to Safely Remove a Tick (2”x5” card):
https://www.health.ny.gov/diseases/communicable/lyme/docs/tick_removal_card.pdf
• Ticks & Lyme Disease Brochure: https://www.health.ny.gov/publications/2813.pdf
• Mosquitoes & Disease: https://www.health.ny.gov/publications/2731.pdf
• Mosquitoes & Diseases (Spanish): https://www.health.ny.gov/publications/2732.pdf
• Protect Yourself Against Mosquito & Tick Bites: https://www.health.ny.gov/environmental/pests/dress_to_repel.pdf
• Tick & Insect Repellent: Deciding on their Use (Spanish): https://www.health.ny.gov/publications/2765.pdf
Additional Tick-borne & Mosquito-borne Materials Available Online:
• NYSDOH Tick Videos and More: https://www.health.ny.gov/diseases/communicable/lyme/
• How to Remove a Tick (Poster):
https://www.health.ny.gov/diseases/communicable/lyme/docs/lyme_disease_alert.pdf
• How to Remove a Tick (Video): https://www.youtube.com/watch?v=oGrK4ZKUfhQ
• Zika: Pregnancy Travel Advisory: https://www.health.ny.gov/publications/13010.pdf
• Zika: Pregnancy Travel Advisory (Spanish): https://www.health.ny.gov/publications/13011.pdf
• Insecticide Use to Prevent WNV – (For Providers): https://www.health.ny.gov/publications/2741.pdf
• Tick & Insect Repellent: Deciding on their Use: https://www.health.ny.gov/publications/2749.pdf
Free NYS Department of Health educational materials are available on a variety of health topics:
• For rabies, go to https://www.health.ny.gov/forms/order_forms/rabies.pdf
• Other health matters, go to https://www.health.ny.gov/publications/4208/
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MATERIALS ORDER FORM FOR TICK-BORNE & MOSQUITO-BORNE DISEASE (New York)

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Completed 21 July 2020

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