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.



Car Seats / Bike Helmets   or

Child Care / Day Care

Child Support (Domestic Relations)

Childhood Immunization
(Health Topics A-Z, Immunizations)

Childhood Lead Poisoning
(Health Topics A-Z, Lead Poisoning Prevention)

Children’s Health Insurance Program (CHIP)

Drug and Alcohol
(Need Help Now?)


Emergency Food Providers and Food Pantries

FDA Food and Safety Recalls 

Head Start / Early Head Start Programs

Healthy Baby Line

Help in PA

Mental Health & Substance Abuse Services 

Migrant Education Program

National Domestic Violence Hotline

National Hispanic Family Health Hotline


School Breakfast, Lunch, and Summer Food Programs

Sexually Transmitted Diseases
(Health Topics A-Z, Sexually Transmitted Diseases)

Special Kids Network System of Care
(Health Topics, Special Kids Network)


Welfare Helpline

Helpful Community Services Links

Forms for Appointments

Tapestry of Health WIC Program