Campaign Book (2)

Lafayette Community Health Care Clinic
Venue Contact Form

Name of Venue: _______________________________________________

Type of Venue: ______________________ employer retail location

If an employer, Number of Employees: _____________________________

Date of Initial Contact: __________________________________________

Contact Person (Name, Position):__________________________________

Phone: _______________________________________________________yesno
Fax: _________________________________________________________
E-mail: _______________________________________________________
Physical Address: ______________________________________________

EXAMPLEMailing Address (if different): _____________________________________
Agreed to Post Flyers (yes or no):

Information Visit Scheduled (date and time): _________________________

3 Month Check-up Complete (date): ________________________________

6 Month Check-up Complete (date): ________________________________

9 Month Check-up Complete (date): ________________________________

12 Month Check-up Complete (date): _______________________________

LCHCC Contact Name and Date (print): _____________________________
LCHCC Contact Signature and Date: ________________________________

Notes (continue on back):
_____________________________________________________________

Lafayette Community Health Care Clinic (LCHCC)
1317 Jefferson Street
Lafayette, LA 70501

Contact: Name
Phone: Number

FOR IMMEDIATE RELEASE

SHORT HEADLINE HERE

<Date>, <City, ST>— Body of story.

####

The Lafayette Community Health Care Clinic has been providing free medical care for the working uninsured in
Lafayette parish since 1992, and offers free prescriptions to eligible patients. The Lafayette Community Health Care
Clinic is the only community clinic in Lafayette parish that operates solely with the volunteer services provided by
local doctors, nurses, pharmacists, and volunteers. We are locals taking care of locals. Information about eligibility,
services, provided, etc. can be found on our web site at www.lafcommunityclinic.org. You can also find us on
Facebook and Twitter. To volunteer or donate, contact Renee Bennett, Director of Volunteer Services, at
(337) 593-9208 ext. 235.

: 30 THE LAFAYETTE COMMUNITY HEALTH CARE CLINIC IS HELPING TO BUILD
ONE HEALTHY COMMUNITY. WE ARE LOCAL DOCTORS, DENTISTS, NURSES,
PHARMACISTS, AND OTHER VOLUNTEERS GIVING OUR TIME TO PROVIDE CARE
FOR THE WORKING UNINSURED IN LAFAYETTE PARISH. IF YOU HAVE A JOB, BUT
DON'T HAVE HEALTH INSURANCE, WE ARE HERE FOR YOU. VISIT US AT L-A-F
COMMUNITY CLINIC DOT ORG OR CALL 5-9-3-9-2-0-8.

:20 THE LAFAYETTE COMMUNITY HEALTH CARE CLINIC IS A COMMUNITY-BASED
EFFORT PROVIDING QUALITY HEALTH CARE FOR THE WORKING UNINSURED. IF
YOU ARE WORKING, BUT DON'T HAVE HEALTH INSURANCE, WE ARE HERE FOR
YOU. TO LEARN MORE ABOUT HOW TO BECOME A PATIENT, DONOR, OR
VOLUNTEER, VISIT US AT L-A-F COMMUNITY CLINIC DOT ORG OR CALL 5-9-3-9-2-
0-8.

: 15 GET THE FACTS ON HOW TO STAY HEALTHY YEAR-ROUND BY VISITING THE
LAFAYETTE COMMUNITY HEALTH CARE CLINIC. IF YOU ARE WORKING AND DO
NOT HAVE INSURANCE, THE LAFAYETTE COMMUNITY HEALTH CARE CLINIC IS
HERE FOR YOU. VISIT US ONLINE AT L-A-F COMMUNITY CLINIC DOT ORG. WE
ARE LOCALS TAKING CARE OF LOCALS.

: 10 AT THE LAFAYETTE COMMUNITY HEALTH CARE CLINIC, WE BELIEVE
EVERYONE SHOULD HAVE ACCESS TO QUALITY HEALTH CARE. TO LEARN MORE
ABOUT HOW WE CARE FOR THE WORKING UNINSURED, VISIT US AT L-A-F
COMMUNITY CLINIC DOT ORG OR CALL 5-9-3-9-2-0-8.

Prevention is your best defense.

1317 Jefferson Street
Lafayette LA, 70506

(337) 593- 9208
For more information visit us at www.lafcommunityclinic.org



LOCALS taking care of LOCALS
BREAUX’S MART