FreeHepatitisInfo - Registration

Mailing List Registration for FreeHepatitisInfo.com

We are pleased to add you to our growing subscriber list for valuable, FREE education on the topic of hepatitis. Please answer the questions below about how you would like to receive this information, and then complete the registration form.

Remember, some of the registration questions are optional, but will help us to continue to improve our knowledge-base of our readership, and better know the demographics of the clients you reach. If you particularly like a program or are interested on a topic, please let us know in the “Comments” section below.

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*For fax/email programs (such as HepatitisWATCH),* please choose how you would like to receive the newsletter:
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When available, please select quantity of Spanish-language materials you would like to receive:

Please include me on all updates for NEW educational programs on hepatitis.

Please include me on all updates for NEW educational programs on HIV.

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OPTIONAL: The following information will help us better know our readers and their clients/organizations so we can provide quality and targeted education. Please take a moment to tell us about your clients/organization.

Population served

Total Consumers:
Total HCV+:
Total HBV+:
Total HCV/HBV+:
Total HIV+:
Total HIV/HCV+:
Total HIV/HBV+:

Population demographics (by percentage)

African American:	%	Latino:	%
Asian/Pacific Islanders:	%	Caucasian:	%
Other:

Gay:

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Transgender:

IVDU:

Substance Users:

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Feedback

If you appreciate what you received from Visionary Health in the past, please give back a little time and energy to let us know which programs are your favorites and why. In addition, let us know what other educational topics you feel are important for you and your clients.

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Privacy Statement: Visionary Health Concepts maintains databases for the sole purpose of distributing free HIV & hepatitis treatment education materials. We don't sell or market any product; names in our database are never traded or sold. Any person listed in our databases will be immediately removed at their request. Mailed materials are always sent in confidential packaging.