Hereditary Cancer Program Resource Materials Order Form
To order free materials, fax this form to 604-707-5931 or email [email protected]
Pamphlets
Does cancer run in my family?
Languages
English
Has anyone in your family had colon cancer?
Quantity
(max 50)
Chinese
(max 50)
Punjabi
(max 50)
English – out of print
(max 50)
Chinese
(max 50)
Punjabi
(max 50)
Other Materials (English only)
Sample Family Tree - Tear Sheet Pad (20 sheets/pad)
5” x 8”
Quantity
5” x 8” laminated reference card (for physicians)
Hereditary Breast and Ovarian Cancer Criteria
(max 5)
Out of stock
5” x 8” laminated reference card (for physicians)
Lynch Syndrome (HNPCC) Criteria
(max 5)
Out of stock
Please complete the following information
DATE:____________________________
PHONE NUMBER: ________________________
NAME: ___________________________
EMAIL: _________________________________
MAILING ADDRESS: ___________________________________________________________
CITY: ____________________________
POSTAL CODE: ___________________________
FAX THIS FORM TO: 604-707-5931 or EMAIL: [email protected] or
MAIL TO: Hereditary Cancer Program, 600 West 10th Ave, Vancouver, BC, V5Z 4E6
Copies of this order form & more information are available at: www.screeningbc.ca/Hereditary
Provide feedback on these materials to Mary McCullum, Nurse Educator by email or 604-877-6000 ext 2325
HCP Use Only – Date sent:__________________