Phone: Is it okay to leave a voicemail?
Text: Is it okay to send a text?
Email: Is it okay to send an email?
Are you currently pregnant?
What sex was your child assigned at birth (e.g. on the birth certificate)
Was the child born prematurely?
Does the child have a known disability?
Have development screening tools been completed?
Does the child have a Primary Care Physician?
Select the Type of Insurance the Child Has
Select Child’s Health Plan If Through Medicaid
How did you hear about Help Me Grow? Choose all that apply.