Use Medicine Safely
Safe Healthcare Project

Questions marked with an asterisk (*) are mandatory.
1

* Please fill out the form below to obtain the brochure "Use Medicine Safely" (Adobe PDF).

Name:
Company:
Address:
City:
State:
Zip Code:
Country:
Email Address:
2

* Type of Organization?
Once you click the Submit button,a copy of the Use Medicine Safely brochure (PDF file) will download and view.

If you do not wish to submit your information electronically, you can fill-in and print this form and mail or fax the Safe Healthcare Project.

Safe Healthcare Project
1725 West 17th Street Room 120M
Santa Ana, CA 92706
(714) 834-8775
(714) 834-8051 Fax