GV Order Form: Self-Care

GrapeVine

Material Order Form

Partner Contact Information: *This question is required.

First Name

Last Name

Date of Session

Self-Care
Please enter the number of copies you need for this session only. Do not order more than needed for this session.

General Materials

If you are interested in ordering Well Badger Resource Center materials, please use the following link.

	Health Care Screening Results Card (WWHF)
	Health Resources Contact List (WWHF)
	Wisconsin Well Woman Program (WWWP) Information / Eligibility Guidelines
	Helping People Help Themselves to Better Health (WIHA)
	GrapeVine Notecard (WWHF) (Limit 5)

Self-Care Materials

	PowerPoint “Self-Care: Awareness, Acknowledgement, Action” (06/2023)
	My Self-Care Workbook
	Influences on Chronic Disease
	My Mental Health: Do I Need Help?
	Emotional Wellness Checklist
	Participant Incentive Gift – Notebook and Inspirational Quotes

Forms

	Educational Session Surveys (also includes Check List, Participant Sign-In Sheet(s), Session Report Form and Return Envelope) [Unit Forms]

Do you have any other requests or comments for this order? Please indicate here if you need any COVID kit materials: Signage with GrapeVine’s Face Covering and COVID-19 Symptoms Policies, box of disposable masks or hand sanitizer.