ReadWell Application Form
NOTICE: This program is currently over capacity. Feel free to submit interested, though supplies are very limited.

BookSpringRx's ReadWell program promotes pediatric literacy in the Central Texas area through partnering with healthcare providers to get books into the hands of families with children under the age of five, with an emphasis on low-income families.  

Please complete this form to apply as a partner for the Readwell program which provides books to distribute to infants and children up to the age of 5 years old, while educating parents about the importance of reading.

The program fee is $0.79 per book.

By signing up for this program, you assure that you will be serving a population of at least 50% or more low income families.

If you have any questions, please email RX@bookspring.org.
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Email *
What is the name of your clinic/healthcare center? *
Site contact name - this is the person the books will be addressed to. *
Site address
Invoice contact name *
Invoice email address - where should the invoice be sent? *
How often would you like to receive books? This can be changed at any time so choose what you think will be best for you to start with. *
How many books would you like to receive in total each time? This can also be changed at any time so choose a number you are comfortable with.  MINIMUM ORDER = 20 BOOKS (if you need less per month consider receiving orders less frequently). *
Your total order will be broken down according to the following age groups. Please indicate what percentage of your total order you would like for each one. Check your choices add up to 100%.
0 - 12 months
12 - 24 months
24 - 36 months
3 - 5 years
10%
20%
25%
30%
40%
50%
60%
75%
80%
90%
100%
What percentage of the total books should be ENGLISH ONLY *
What percentage of the total books should be SPANISH ONLY *
What percentage of the total books should be bilingual ENGLISH / SPANISH ONLY? *
What other languages are you looking for?
Are you able to share information with families and if so, how? We have some great resources we would love to share with the families you serve but want to make sure that we create them in a usable format. *
Required
I assure that our clinic serves at least 50% low income families. *
Have you received any Reach Out and Read training?
Clear selection
Have you heard of our new B3 Mobile app? 
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A copy of your responses will be emailed to the address you provided.
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