Parents Health Education
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ORDER FORM

You have two choices for ordering.

Printable Fax/Order Form

or fill out the Online Form provided below.

Enter the quantity of items ordered into the blanks provided:

Product Name Price # Ordered
Written Instructions
(Set of 4)		 $5.00
Getting Started Breastfeeding Package: Video & set of Written Instructions $39.99 + Shipping & Handling

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Bill To:

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