Syphilis Elimination Project: Materials Order Form

Please complete the order form below and click "submit."

Complete Kit
Number requested
Includes samples of each item listed below
Patient materials

* = included in the tool kit
PDF = available on line. To access PDF version, click on image.
Number requested
“Listen Up…”
partner self-referral cards*
listen up card
“What you should know…”
MDH tri-fold syphilis brochure* (PDF)
brochure image
Syphilis outreach cards Number requested
2”x3.5” African American man* contact card image
2”x3.5” Caucasian man* contact card image
4”x6” “You think it always hurts to pee...”* you think it always hurts to pee when you get an STD?
4”x6” “You May Get Syphilis” * you may get syphilis image
Tools for clinicians Number requested
Physician’s pocket reference* (PDF) clinician's guide image
Sample clinic protocol* (PDF) and
Syphilis: Aid to Diagnosis* (PDF)
Risk assessment tool (PDF)
Risk assessment guidance* (PDF)

“Health care and Men who Have Sex With Men: Challenges and Opportunities” resources

Number requested
Training materials
MSM: Clinician’s Guide to Incorporating Sexual Risk Assessment in Routine visits* (PDF)
Talking About Safer Sex With Your Patients* (PDF)
10 Tips for Working With Transgender Individuals* (PDF)
Creating a Safe Clinical Environment for Men Who Have Sex With Men* (PDF)
Tips for Working With Bisexually Identified and Behaviorally-Bisexual clients* (PDF)
MSM friendly lobby posters
(to access PDF version, click on poster image below)
(specify size) 8.5”x11” 11”x17”
“We care about your needs, whomever these lips kiss”* (PDF) poster
“We care about your needs, whomever these hands caress” (PDF) poster
“We care about your needs, whomever these hands embrace” (PDF) poster
“We care about your needs, whomever this heart holds dear” (PDF) poster
“We care about your needs, whomever these arms hold” (PDF) poster
“We care about your needs, whatever pronouns you use” (PDF) poster
“Safe Zone”* (PDF) poster
“Zona Segura,” “Safe Zone” in Spanish (PDF) safe zone poster spanish
“I’m Willing To Talk About…”* (PDF) poster
“Estoy Dispuesto A Hablar Sobre…,” “I’m Willing To Talk About” in Spanish (PDF)
Complete set of posters, one each* (PDF)

Contact Information

Agency Name

Contact Person
Contact Phone

Contact E-mail
Mailing address
City
State
Zip
To prevent abuse of this form, please type the following letters/numbers WX94B into the field below. Thank you.
required

For more information on syphilis, call 651-201-5414

If you have technical difficulties using this form, you may print the PDF version of this order form and mail it in, or contact Kathy Anderson via e-mail.