McLaren Bay Region Magnet Request Form

If you would like a free stroke symptom, heart attack or fall prevention magnet, please complete the form. It will be sent out via U.S. mail shortly.

*Indicates required information

Patient First Name: *

Patient Last Name: *

Address Line 1: *

Address Line 2:

City: *

State: *

Zip Code: *

Email Address: *

Please choose which magnet(s) you would like: *

Stroke Symptom Magnet	Heart Attack Magnet
Fall Prevention Magnet

Captcha*