Wearing Masks Online Order Form
Wearing Masks II (WM I is included in the WMII DVD) • Wearing Masks III • Wearing Masks IV
Substance Abuse Policies for Anesthesia, Time to Re-Evaluate Your Policies and Curriculum, by Bernadette T. Higgins Roche is now availalble

Both DVDs and books are available free of charge

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We would like to know some information about you: (all right to check more than one box)

Are you a physician/ anesthesiologist? yes     no How many people would see this?
        Academic Program
        Private Practice Group
        Hospital/Outpatient Anesthesia Department
        Individual Seeking Information
Are you a CRNA? yes     no
        Academic/Teaching Program
        Employed by Hospital
        Employed by Anesthesiology Group
        CRNA Group
        Solo Practice
        Individual Seeking Information
Do you belong to a Physicians Health Program? yes     no       
       Physician
       Administrator
Are you a non-medical person seeking information/resources? yes     no
Other:
        Surgery        O.R. Staff        Hospital Staff        Hospital Administration

Whatever your occupation/affiliation, would you be willing to share feedback from your substance abuse sessions with us?
We are developing tools of evaluation of the Wearing Masks programs and your assistance would be appreciated.
Yes     No
 

Select the item/s you are ordering:

  • Portfolio (includes, Substance Abuse Policies for Anesthesia (Book), 3 DVDs (Wearing Mask II, II, IV), and Guidebook for Developing Substance Abuse Policies and Procedures and Educational Programs. Only 1 available per institution, please

  • Substance Abuse Policies for Anesthesia (Book)

  • DVDs: Wearing Mask II (includes WMI)        Wearing Mask III  (WMIII is out of stock)      Wearing Mask IV
Quantity (Number of DVDs you are requesting): *
How many substance abuse sessions do you intend to conduct per year?
 

Ship To:
Name: *     

Position: *

Department:

Affiliation/Institution: *

Address: *

City: *  
   
State: *

Country:   *
    
Zip: *

Daytime Phone: *   

Fax:   

E-mail: *

For info contact:

All Anesthesia
Attn: Brenda McCrain
PO Box 571009
Winston-Salem, NC 27157-1009

Phone: 336.716.4498
Fax: 336.716.8190
Allow 3 weeks for shipping.