Get the free Healthy Babies Healthy Children Program Referral - for Community Agencies.docx
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Healthy Babies Healthy Children Program Referral
Fax to: 5193761287
Client ___Date of Birth ___Partner ___Age or Date of Birth ___YYY/MMM/address ___
Phone (s) ___
Child (men’s Name Date of Birth
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How to fill out healthy babies healthy children
How to fill out healthy babies healthy children
01
Obtain the Healthy Babies Healthy Children screening form from a public health unit or healthcare provider.
02
Fill out the personal information section including the child's name, date of birth, address, and contact information.
03
Answer the questions about the child's development, behaviour, and family situation honestly and to the best of your knowledge.
04
Sign and date the form before submitting it back to the public health unit or healthcare provider.
Who needs healthy babies healthy children?
01
Parents or guardians of children under the age of 6 who are interested in monitoring their child's development and accessing early intervention services.
02
Healthcare providers who want to identify and support children at risk of developmental delays or health concerns.
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