COMMUNICABLE DISEASE FORM FOR TICK-BORNE & MOSQUITO-BORNE MATERIALS
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
PO Box 343
Guilderland, NY 12084

Email address: [email protected]
Please allow 2 to 3 weeks for delivery.
Last Update 3/15/2017
----------------------------------------------------------------------------------------------------------------------------- --------------------------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”)
2815 New York State Tick ID Card (~2” x 3 ½”)
2813 Ticks & Lyme Disease Brochure*
2737 Health Advisory- Tick and Insect Repellents
PP12 Warning – Ticks in the Area May Cause Lyme
Health Care Provider Education on Tick-borne Disease:
2823 Diagnosing Tick-borne Disease
Card
Card
Brochure
Brochure
Metal Sign
1
1
1
1
1
10
10
10
10
10
50 100
50
50 100 200
50 100 200 300
Laminated sheet
1 10 50 100 200 300
Brochure
Magnet
Brochure
1 10 50 100 150 200
1 10 50 100 200
1 10 50 100 200 300
Environmental Control
2738 Anvil® and Mosquito Control
2740 Malathion and Mosquito Control
2757 Protect Your Home Against Mosquitoes
2759 Protect Your Home Against Mosquitoes (Spanish)
2723 Reducing Pesticide Exposure
2739 Scourge® and Mosquito Control
2750 What Do I Do if There is Spraying in My Community?
Fact sheet
Fact sheet
Poster
Poster
Brochure
Fact sheet
Fact sheet
1
1
1
1
1
1
1
10
10
10
10
10
10
10
50
50
50
50
50
50
50
West Nile Virus (WNV)
2741 Insecticide Use to Prevent WNV *– (For Providers)
2747 WNV: Do Mosquitoes Love Your Home and Yard?
2746 WNV: Frequently Asked Questions
2742 WNV Information for Outdoor Workers
2751 WNV: Senior Citizens
2748 WNV: Suggested Community Activities
PP67 WNV and Transplant Recipients
PP70 WNV is a risk you can do something about. (Spanish)
Fact sheet
Fact sheet
Fact sheet
Fact sheet
Fact sheet
Fact sheet
Brochure
Palm cards
1
1
1
1
1
1
1
1
10
10
10
10
10
10
10
10
50 100 200
50 100 200
50 100 200
50 100 200
50 100 200
50 100 200
50 100 150
100 200
Mosquito-borne Disease Materials:
2731
2733
2732
Mosquitoes & Disease*
Mosquitoes & Diseases
Mosquitoes & Diseases (Spanish)*
100
100
100
100
150
200 300
200
200
100 150
100 200 300
300
300
300
300
300
300
200
Zika Virus
13010 Zika: Pregnancy Travel Advisory*
13011 Zika: Pregnancy Travel Advisory (Spanish)*
Poster
Poster
1 10 50 150
1 10 50
Mosquito & Tick-borne Materials:
2714
2761
2816
2817
2749
2765
Protect Yourself Against Mosquito & Tick Bites
Flyer
Protect Yourself Against Mosquito & Tick Bites*
Poster
Protect Yourself Against Mosquito & Tick Bites (Spanish) Flyer
Protect Yourself Against Mosquito & Tick Bites (Spanish) Poster
Tick & Insect Repellent: Deciding on their Use*
Brochure
Tick & Insect Repellent: Deciding on their Use (Spanish)*Brochure
1
1
1
1
1
1
10
10
10
10
10
10
50 100 200
50
50
50 100 200 300
50
50 100 200 300
Additional materials available only online:
How to Remove a Tick*
How to Remove a Tick (Video)*
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:
* Click title to view and/or print material.
Additional free NYS Department of Health educational materials available:
 For rabies, go to www.health.ny.gov/forms/order_forms/rabies.pdf
 Other health matters, go to www.health.ny.gov/publications/4208/