STOP Shipping Label Request

STOP Program Shipping Label Request

Please complete all the information in this form in order for your shipping labels.

If you have any questions please contact us at stop.study@camh.ca .

Page 1 of 1

Which one of the following organization types do you belong to?

* must provide value

Organization/Agency Name:
(Addictions or Mental Health Agencies)

* must provide value

Organization/Agency Name:
(NPLCs)

* must provide value

Organization/Agency Name:
(CHCs)

* must provide value

Organization/Agency Name:
(FHTs)

* must provide value

Please include the delivery address for the shipping labels.
For first name, please include the name of the person responsible for shipping or the main contact for STOP at your organization.

First Name:

* must provide value

Last Name:

* must provide value

Street Address:

* must provide value

Floor, Unit, Room #:

City / Town:

* must provide value

Postal Code:

* must provide value

Phone Number (XXX-XXX-XXXX):

Extension

Please note:

If you are ordering documentation for more than one site please complete a survey for each site separately.

That can be either for a different organization or for multiple locations within one agency (AA/FHT/CHC/NPLC) OR if your agency is using the Multi-Site Model and treating each site as separate in the STOP Portal.

Please indicate the number of forms you would like to order:

English Consent Forms:

English Registration Forms:

English Baseline Forms:

English Visit Forms:

English Posters:

English Flyers:

_____________________________________________

French Consent Forms:

French Registration Forms:

French Baseline Forms:

French Visit Forms:

French Posters:

French Flyers:

_________________________________________________

Do you need more shipping labels/waybills (to attach to your document packages) sent to your site?

Yes

reset

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.