Tobacco Prevention and Control Program
Order Form

             

If you have questions call 800.280.5512, select option 3.

Enter the quantity wanted for each item and the information requested below and press the "Submit" button at the bottom of the page.

Please limit quantities to 250 per item per quarter and allow 2 to 4 weeks for delivery.

 
Brochure              
NDQuits Brochure       NDQuits Pregnancy Brochure           
               
Patient Information palm card (2.75 x 11)               
NDQuits Smoking        NDQuits Smokeless        
               
Posters              
NDQuits for Tearoffs (8.5x11)   
(2 Tearoff Pads per Poster)		    Use NDQuits (8.5x11)   
  Use NDQuits (11x17)
 
               

Safe Sleep Poster - American Indian (8.5x11)   		      Safe Sleep Poster - General Population (8.5x11)          
               
Other      
20-Minutes foldover card (3x2.5)         Tobacco Education Guide 
    Wallet Card   
                
Tearoff Sheet   
(limit of 2 pads per NDQuits for Tearoffs Poster)		   Easel for Posters         NDQuits Pocket Guide     

One full sheet of paper folded to
easily fit into a shirt pocket.  
            Great tool for healthcare providers to understand NDQuits services. Also includes information on Nicotine Replacement Therapy (NRT) dosing, reducing nicotine withdrawal symptoms, and comparing the daily costs of NRT to smoking a pack a day. 
               
               

                                     

Date:   

Name:    

Business/Health Agency Name:    

Mailing Address:   

City:      State:   Zip:        

Phone Number:        

Email:    

Date Needed:     

 
               
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If you experience trouble submitting the form online, you can call your order in to the North Dakota Division of Chronic Disease at 800.280.5512 or 701.328.3398.