Patient Education E-Form

Select patient education materials to be emailed here. Materials are unbranded and ad-free. Any other recommendations can also be typed or pasted manually.


Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page: (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020). Important: Delete this tip before you publish the form.
Patient Name*
Prescriber Name*
Patient Education Selection*
(Check all that apply)

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