How Can We Support You?

As Live Well Allegheny continues to grow, we want to support your health initiatives and connect you to our network of resources. Please fill out the referral form below:

Our apologies! We are experiencing difficulties with our electronic forms. Please send the following information in an email to the Live Well Allegheny Administrative team:

Organization Name:
Your Name:*
Address:
City:
Zip Code:
Phone:*
Email Address:*

I am interested in resources for:
Healthy Eating | Physical Activity | Smoking Prevention/Cessation |Other (please be specific)

What type of resource?
_I’d like help connecting with another Live Well organization
_Education materials
_Our organization would like to host a Live Well event
_Participate in a tabling exercise
_Partner packet
_Receive Partner E-Update Newsletters

Please describe what you’re looking for here:
[Examples:
“I’m a teacher and would like electronic access to MyPlate info.”
“I’m seeking printed materials on smoking cessation to distribute at a local event.”
“Our organization would like to host a speaker about incorporating wellness into the workplace.”]

* – denotes required fields