UpToDate Patient Education Materials Request Form

Complete this form to receive UpToDate's free patient education materials for your practice or hospital.

(Currently only available to UpToDate subscribers in the continental United States and Canada)
Patient Education Materials

patient script pad
click on image to enlarge		 Pads: Use the pads to prescribe information for your patients. Pads are 5 ½ x 4 ¼ with 50 sheets per pad.
patient poster
click on image to enlarge		 Posters: Hang the posters in your waiting room or exam room. Posters are 11 x 17, with mini tear-off pad.

Select A Package (You can select more than one)


Package 1
Starter Kit: 6 pads 		Package 2
Refill Kit: 20 pads 		Package 3
Starter Kit: 3 posters, 6 mini tear-off pads 		Package 4
Refill Kit: 10 mini tear-off pads

Need larger quantities? Email us at patients@uptodate.com.

Provide Shipping Information (we cannot ship to a P.O. Box)

to automatically fill out the form with your information, please log in
(* required field)
*Title:
*First Name:  
Middle Initial:  
*Last Name:  
Suffix  
Organization:  
*Address 1:  
Address 2:  
Address 3:  
*ZIP/Postal Code:  
*City:  
*County:  
*State/Province:
U.S. and Canada Only 		 
*Country:  
*Email Address:  
*Verify Email Address:  
We respect your privacy and will not share your contact information with any third party. This information will be used only to provide subscription services to you.

*Telephone Number:   Extension
This is: Work Home Cell

Alternate Telephone Number:   Extension
This is: Work Home Cell

Fax Number:  



white circle LOG IN
white circle DEMO