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Flyers & Referral Forms

/Flyers & Referral Forms
Flyers & Referral Forms 2020-10-22T14:55:25+00:00

Download Flyers & Referral Forms Directly from our Website!


Free Evidence-Based Health and Wellness Programs

Are you interested in signing up for free health education programs?

Click this link to submit an interest form and we will contact you soon to complete the registration process.

https://www.cognitoforms.com/forms/admin/view/northeastfloridaahecprograminterestcontactform/build

Tobacco Free Florida AHEC Cessation Program Referral Form

Healthcare providers, please use this form to refer your clients to free tobacco cessation programs.

Electronic Referral Form:

https://www.cognitoforms.com/NortheastFloridaAHEC/healthcareproviderreferralformtotobaccofreeflorida

Tobacco Free Florida AHEC Cessation Program

Virtual Class Options

In-Person Class Options

Baker County

Clay County

Duval County

Flagler County

Nassau County

St. Johns County

Volusia County

Opioid Prevention and Treatment Education

Wellness Program Referral Form

Healthcare providers, please use this form to refer your clients to free health and wellness education programs.

Electronic Referral Form:

https://www.cognitoforms.com/NortheastFloridaAHEC/healthcareproviderreferralformtonortheastfloridaahec

Wellness Program for Adults Age 60+

Overview

Diabetes Empowerment Education Program

Diabetes Self-Management Program

Living Healthy: Chronic Disease Self-Management Program

Medication Management Program

Mental Health Counseling Program

Shopping Assistance Program

Telephone Reassurance Program


Documents are available for download in PDF format.

Additional file formats are available upon request (Word, JPEG, PNG, etc.)

Please email requests to Vanessa Salmo at vsalmo@northfloridaahec.org