Appointment Scheduling and Health Educator Contact Request

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Our service area includes the following 18 counties:

If you do not live in our 18-county service area, you can reach out to your local health department for additional information and resources.

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Full Name* This field is required.

First Name

Last Name

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Request Type* This field is required.

Schedule an appointment

Speak with a Health Educator

Schedule an appointment and speak with a Health Educator

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Phone Number* This field is required. To schedule an appointment, a staff member MUST speak with you over the phone.

Please enter a valid phone number.

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Email* This field is required.If you do not have an email address, type none@none.com

example@example.com

Confirm Email

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Preferred Method of Contact* This field is required.Choose all that apply. Please note: A staff member must speak with you on the phone to schedule an appointment.

Phone

Text

Email

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Preferred Language* This field is required.

English

Español (Spanish)

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Leave us a noteUse this space to include details about your request or questions you may have so we can be better prepared when we contact you.