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Your Information

Your Name(Required)
Agency: La Plata County Public Health
Agency Services:
Birth and Death Certificates
Cancer Screening
Clinic Services
Communicable Disease Prevention
Harm Reduction Program
Insurance Assistance
Nurse-Family Partnership
Suicide Awareness and Prevention Program
Tobacco Cessation and Education
Women, Infants, and Children (WIC)
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Program Information

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Address(Required)
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Accepted file types: pdf, docx, ods, txt, Max. file size: 3 MB.
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Accepted file types: jpg, jpeg, png, webp, svg, Max. file size: 2 MB.
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Social Media Accounts
Site Name
Social Media URL
 
Add your social media accounts. e.g., Site: Facebook |

Social Media URL: https://facebook.com/myUrl
| Use the plus sign to add additional Social Media items.
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Counties Served (check all that apply)(Required)
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