Order Form

Ordering BMI Screening Materials
For more information, go to the New York State Department of Health (NYSDOH) Web site at:
http://www.health.ny.gov/prevention/obesity/bmi_screening_tools.htm
To order copies, complete this form and mail to:
NYSDOH Distribution Center
PO Box 343
Guilderland Center, NY 12084
Email: [email protected]
Items are free for New York State organizations. Please allow at least three weeks for
delivery. PLEASE NOTE: We do not mail to P.O. Box addresses.
Item
Circle Quantity
#4950 BMI Wheel
1 2 3 4 5 (limit 5)
#4948 Boys BMI-for-Age Growth Chart (pad of 25)
1 2 3 4 5 (limit 5)
#4949 Girls BMI-for-Age Growth Chart (pad of 25)
1 2 3 4 5 (limit 5)
#4987 Boys BMI-for-Age Growth Chart Laminated Poster (17’’ X 22”)
1 2 3 4 5 (limit 5)
#4988 Girls BMI-for-Age Growth Chart Laminated Poster (17” X 22”)
1 2 3 4 5 (limit 5)
Print contact information:
Name:___________________________________________________________________
Organization:_____________________________________________________________
Address:_________________________________________________________________
City/State/Zip: ____________________________________________________________