Distribution Request Form
for Prenatal Care Providers (Ob/Gyns, Midwives, and Hospitals)

If you would like to request free copies of the Expectant Mother's Guide for distribution to your first-time expectant patients, please submit the form below -OR- fax your request on letterhead to 412-278-4906.

Name:
Title:
Organization/Practice Name:
Street: (no PO Boxes)
City:
State:
Zip:
Phone:
Fax:
E-mail:
Which edition are you requesting?
How many complimentary copies would you like to receive?
How many pregnant women do you see annually?
Of this number, how many are first-time mothers?
Generally, how/where will you be distributing the guide?
Would you like your organization to be a featured service in the new print edition and on www.ExpectantMothersGuide.com?

Yes
No

If so, who should we contact regarding our advertising packages?
Comments or suggestions for editorials:

No information provided from this form will be given or sold to a third party.

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