Forms for Appointments

Is your next appointment a certification?  You can save time by completing these forms from home. 

If mom is being certified, complete the Women’s Questionnaire

For children 1-4 complete the Child’s Questionnaire

For infants less than 12 months old use the Infant Questionnaire.

AIDS
www.choice-philadelphia.org

Breastfeeding

http://healthfinder.gov/HealthTopics/Category/pregnancy/getting-ready-for-your-baby/breastfeed-your-baby

http://www.womenshealth.gov/breastfeeding/

http://www.babycenter.com/breastfeeding-basics


Car Seats / Bike Helmets
www.pasafekids.org   or

www.nhtsa.dot.gov

Child Care / Day Care
www.dhs.pa.gov

Child Support (Domestic Relations)
www.childsupport.state.pa.us

Childhood Immunization
www.health.state.pa.us
(Health Topics A-Z, Immunizations)

Childhood Lead Poisoning
www.health.state.pa.us
(Health Topics A-Z, Lead Poisoning Prevention)


Children’s Health Insurance Program (CHIP)
www.chipcoverspakids.com

Drug and Alcohol
www.ddap.pa.gov
(Need Help Now?)

Education
www.literacydirectory.org

Emergency Food Providers and Food Pantries
www.feedingamerica.org


FDA Food and Safety Recalls

http://www.fda.gov/Safety/Recalls/default.htm 

Head Start / Early Head Start Programs
www.paheadstart.org


Healthy Baby Line
www.dhs.pa.gov

Help in PA
www.helpinpa.state.pa.us

Mental Health & Substance Abuse Services
www.dhs.pa.gov 


Migrant Education Program
www.education.state.pa.us

National Domestic Violence Hotline
www.thehotline.org

National Hispanic Family Health Hotline
www.hispanichealth.org


PA WIC

www.pawic.com

School Breakfast, Lunch, and Summer Food Programs
www.education.state.pa.us

Sexually Transmitted Diseases
www.health.state.pa.us
(Health Topics A-Z, Sexually Transmitted Diseases)

Special Kids Network System of Care
www.health.state.pa.us
(Health Topics, Special Kids Network)

Text4Baby
www.text4baby.org

Welfare Helpline
www.dhs.pa.gov

Helpful Community Services Links

Forms for Appointments

Tapestry of Health WIC Program