Electronic Order Form for TeamSTEPPS Materials

TeamSTEPPS

Order Form for Department of Defense or TRICARE Requests

Fill in the requested information and select the Submit button below to send your request. Your order will be received and processed during normal business hours at the AHRQ Publications Clearinghouse.

(If you are not in the Department of Defense or TRICARE, go to a separate order form.)

1. Choose Products to Order (only allowed one copy of each product per order) *

TeamSTEPPS Pocket Guide (for DoD customers only)

TeamSTEPPS Multimedia Resource Kit (CD-ROM and DVD disk wallet) (for DoD customers only)

TeamSTEPPS Poster (size: 17 x 22) (for DoD customers only)

TeamSTEPPS Rapid Response System (for DoD customers only)

2. Provide Order Delivery Information

First Name:

Middle Initial:

Last Name:

Organization:

Department:

Address 1:

Address 2:

City:

State/APO/FPO:

ZIP/Postal Code: *

Country:

( * indicates required field )

3. Provide E-mail address to receive order confirmation

E-mail address:

U.S. Department of Health and Human Services

Agency for Healthcare Research and Quality