KTPC Print Materials Request Form

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If you would like the Kentucky Tobacco Prevention & Cessation Program (KTPC) to mail promotional materials to your organization, please complete the following form.

All orders are subject to availability. If we are unable to fill your order as requested or if there will be delays on our side, we will contact you at the email or phone number you share below. Materials marked with **Last Chance** are available on a first come, first served as they will not be reordered after current stock is depleted.

There is no cost for you to have us mail promotional materials to you. We are able to provide this service through Master Settlement Agreement funds. However, KTPC reserves the right to refuse any materials request. If we will not be able to fill your request, we will notify you in an email.

If you have questions about this process or about your order, please contact KY.TobaccoFree@ky.gov.

Additional materials are also available for you to print yourself (e.g., other fact sheets) or for you to adapt to your needs (e.g., billboards, banners, etc.) at no cost. To access these, please email KY.TobaccoFree@ky.gov with "Digital Materials Request" in the subject line to be connected to the KTCP Communications Specialist.

Contact Person Name *

Organization Name *

Organization Type *

Local Health Department

Hospital

Dentist

Medical Clinic

Other Health Care Provider

School

Recovery Community Center

Other:

Required

Mailing Address *

Phone Number *

Email Address *

I would like to receive the Tobacco Prevention & Cessation Program's monthly newsletter at the email address listed above. (This response will not affect your ability to receive print materials.) *

Yes

Quit Now Kentucky Materials

Materials to promote 1-800-QUIT-NOW and QuitNowKentucky.org. (Quit Now Kentucky is our quitline for all ages.)

Quit Now Kentucky Referral Card **Temporarily Unavailable Due to 797979 Discontinuation**

3.5'' x 2'' business cards, double-sided. You may print your own updated referral cards (using "Text QUITNOW to 333888") by using the file available here: https://drive.google.com/file/d/1d6E84IZyGg8fZTsVx4e7xA5MZxSaykvD/view?usp=sharing

Notify me when this is back in stock

Other:

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Quitters Always Win Referral Card

3.5'' x 2'' business cards, double-sided. You may print your own referral cards (using "Text QUITNOW to 333888") by using the file available here: https://drive.google.com/file/d/137Y0SaeHZ_yGsP5mDj6eor1foxXmhdom/view?usp=sharing

100

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500

Other:

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Kick Butts Referral Card

100

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400

500

Other:

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Quitting for Two (Pregnancy) Referral Card

100

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400

500

Other:

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Quit Now Kentucky Tri-fold Brochure

3.68'' x 8.5'' tri-fold brochure on glossy paper

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Other:

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Quit Now Kentucky Poster

11'' x 17'' poster on card stock, single-sided

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200

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Co-branded Quit Now Kentucky and My Life, My Quit Materials

Quit Now Kentucky Fact Sheet for General Audiences

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheet.pdf

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Quit Now Kentucky Fact Sheet for Pregnant or Postpartum Clients

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetPregnancy.pdf

I will print these myself

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Quit Now Kentucky Fact Sheet for Public Housing, Medicare, and Uninsured Audiences

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetPHA.pdf

I will print these myself

Clear selection

Quit Now Kentucky Fact Sheet for Behavioral Health Needs

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetBH.pdf

I will print these myself

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Quit Now Kentucky Fact Sheet for Young Adults

Available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/QNKFactSheetYA.pdf

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Quit Now Kentucky AND My Life, My Quit "Rx Pads"

5.25'' x 4.25'' mock prescription pad with tear-off sheets printed with Quit Now Kentucky promotion on one side and My Life, My Quit promotion on the other side. These are not sticky notes.

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My Life, My Quit Materials

Materials to promote MyLifeMyQuit.com or texting "START MY QUIT" to 36072. (My Life, My Quit is our quitline for ages 17 and under.)

MLMQ Quit Vaping Referral Card **Out of Stock**

3.5'' x 2'' business cards, double-sided

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Vaping is Still Tobacco Poster **Out of Stock**

11'' x 17'' poster on card stock, single-sided

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Other:

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Cut Out Vaping Poster **Out of Stock**

11'' x 17'' poster on card stock, single-sided

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Other:

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Vaping Wasn't Just A Trend Poster **Out of Stock**

11'' x 17'' poster on card stock, single-sided

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Other:

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Vaping Clouded My Future Poster

11'' x 17'' poster on card stock, single-sided

Other:

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I Broke Up With My Vape Poster

11'' x 17'' poster on card stock, single-sided

Other:

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Types of NRT (Audience: Public) **NEW**

8.5'' x 11'' single-sided. Not yet available for ordering, but can be downloaded and printed from: chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/NRTflyer.pdf

I will print these myself.

Other:

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Other Materials

The 5 Rs (Audience: Health Care Providers)

Available for download at: https://bhwell.uky.edu/sites/default/files/2022-04/5Rs%20simple%20021622.pdf

I will print these myself.

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The 5 As (Audience: Health Care Providers)

Available at: https://bhwell.uky.edu/sites/default/files/2022-04/5As%20simple%20021622.pdf

I will print these myself.

Other:

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Tailored Tobacco Treatment (Audience: Health Care Providers)

Available at: https://bhwell.uky.edu/sites/default/files/2022-04/Pharmaco%203.0%20KP%20022522.pdf

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Other:

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Tobacco Cessation & Recovery (Audience: Health Care Providers)

Available at: https://bhwell.uky.edu/sites/default/files/2022-04/Tobacco%20Cessation%20and%20Recovery%20PMI.pdf

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Tobacco Treatment Reimbursement (Audience: Health Care Providers)

Available at: https://bhwell.uky.edu/sites/default/files/2022-06/Tobacco%20Treatment%20Reimbursement%20Guide.pdf

I will print these myself.

Other:

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Medicaid & MCO Tobacco Cessation Benefits (Audience: Health Care Providers)

8.5'' x 11'' double-sided, printed on cardstock. Also available at: https://chfs.ky.gov/agencies/dph/dpqi/cdpb/hpdocs/MedicaidandMCOTobaccoCessationBenefits.pdf

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Questions (Optional)

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Comments (Optional)

Consider sharing ideas of other print materials that would be helpful to you in the future, information about whether you are requesting these for a specific event or on behalf of a local partner, etc. Please reference the file name wherever relevant.

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