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Healthy Start/Healthy Families On-Line Referral

Anyone in Clackamas County who is expecting or has had their first child in the past three months may be eligible to receive home visits and one-on-one parenting support. All other Clackamas County families with children ages 0-5 may join our free weekly play groups that are offered throughout Clackamas County. Resources about local parenting classes are also available. We offer a variety of services that give information about parenting, bonding with your baby, healthy infant growth and development as well as resources in your community. Please fill in your information below and we’ll be happy to contact you and help you find resources that best fit your needs!

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I am filling out this form for someone else

Name and title of person completing form (if other than mother):

If you are filling out this form for someone else, has this person given you verbal permission to complete this on-line referral form for them?
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Mother's Name:

E-Mail:

Mother's Date of Birth (mm/dd/yyyy):

Address:

City:

State:

Zip:

Phone:

Baby's Date of Birth or Due Date:

Primary language spoken at home:
English
Spanish
Other

Comments:

By clicking Submit, you give Healthy Start/Healthy Families of Clackamas County your permission to contact you to share more information about Healthy Start.

If you do not live in Clackamas County, please contact your local Healthy Start/Healthy Families Program:

  • Multnomah County: 503-988-3674 ex: 29770
  • Washington County: 503-846-4534
  • Marion County: 503-362-3138
  • Yamhill County: 503-434-7425 ex: 4713