Order Form for Self Exam Kit

Self Help Kit Contents

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Self Exam Kit

	Plastic Speculum (medium)
	Hand held Mirror
	Flashlight & instruction booklet

$25.00

Plastic Speculum only

$15.00

Print this form and send with a check payable to WHS.

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Public Relations Department

C/O WHS
1750 Wright Street, Suite 4

Sacramento, CA 95825