Deterra Product Request

Inspira Health Network provides the Deterra product to community agencies in Gloucester, Cumberland and Salem counties free of charge. In an effort to measure the impact, we request that you promote the survey to those who receive the product.

To submit a request for a supply of Deterra, please complete the form below.
  
*
Agency name:
*
Your name:
*
Email:
*
Phone number:
*
Number of units requested (maximum per request is 1,000 pouches):
*
Distribution method including target audience:
*
Tracking method (Briefly describe in 2 to 3 sentences how you will collect completed surveys):
Security Code
Type Security Code

If you have questions about the Deterra product and community outreach, please contact us at CommunityBenefits@ihn.org or (856) 641-6356.