Please read and sign to consent to services:
Florida’s Healthy Start is a voluntary program for pregnant women and infants up to age three. The program is based on need, not income. Immigration status does not matter. There is no cost for care coordination services, home visits, or classes. If you agree to participate, a Healthy Start staff member will contact you to address any special needs you or your baby may have, and help you find services in your community that can meet those needs. At any time in the program, you can decline Healthy Start coordination, and this will not impact any services that you are receiving from your provider of care, or any other agencies you may be involved with. I accept the invitation to participate in Florida’s Healthy Start Program. I authorize the exchange of my information between the Healthy Start Program, Healthy Start Providers, Healthy Start Coalitions, Healthy Families Florida, WIC, Florida Department of Health, and my health care providers for the purpose of providing services, paying for services, improving quality of services or program eligibility. I authorize Healthy Start to contact me about getting connected to services.