The Partnership for Home Visiting includes Parents as Teachers, Nurse Family Partnership, and SafeCare available through LCPH and Florence Crittenton
This form takes about 4 minutes to complete. Please note, by filling out this form you are not obligated or enrolled in this program. Lewis and Clark Public Health will contact you with more information.
Tell us about yourself, please.
Name
*
First Name
Last Name
Date of Birth
*
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Month
-
Day
Year
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PAT, NFP, and SafeCare are not available in every county. What is your county of residence?
*
Are you pregnant?
*
Yes
No
Unknown
What is your due date?
*
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Month
-
Day
Year
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How old is your youngest child?
*
How can we contact you?
E-mail
*
example@example.com
Phone Number
*
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Area Code
Phone Number
What is your preferred contact method?
*
Please Select
Email
Phone
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