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FREE FIRST AID KIT for telling us a little about yourself.

To get your FREE FIRST AID KIT, along with information on the programs and services offered at Texas Health Harris Methodist Hospital Stephenville, simply complete the form below.
Gift Code: 
       (Please refer to the bottom left corner of your letter.)
First Name:  Middle:  Last: 
City:  State:  Zip: 
( i.e., XXX-XXX-XXXX )

By providing an email address, you agree to receive periodic information on health-related events and information on leading a healthy lilfestyle.  You may opt out at any time.
Date of Birth:
  Gender: Female
Number of children in household? Age 5 or under:  Age 6-11:  Age 12-17: 
Do you have a primary care physician? Yes
YES - Send me Health-E News, the FREE monthly eNewsletter of Texas Health Resources, covering relevant health topics and tips for living a healthy lifestyle.

I'd like to receive the following information from Texas Health Stephenville:
Healthy Woman KitPregnancy Planning KitWellness Classes & Support Groups
Healthy Man KitHospital Overview  
Healthy Heart KitHealthy Eating Guide  
Healthy Kids KitDiabetes Wellness Kit  

From time to time Texas Health Resources may send you information periodically by mail.  If you prefer to be excluded from these communications, please indicate below:
I do not wish to receive information by mail

Texas Health Resources will not rent, sell or exchange your information.  All information will be treated as confidential.  You may opt out at any time from any future communications.
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