Refer a Child or Family
HMG Vermont is a free service for all prenatal parents and families with young children through age eight. Fill out and submit this form on behalf of a child or family in order to:
• Connect a parent or caregiver to developmental resources and services
• Request information on child development, pregnancy, or positive parenting skills classes
• Refer a family for a developmental screening
• Get help for a family with navigating social services, problem-solving and advocacy
• Request personalized care coordination to support a child and family
• Receive follow up as a referring provider
For questions, please call us at 2-1-1 x6 or email us at email@example.com. After submitting this form, a child development specialist will contact the parent/caregiver and will also follow up with the referring provider (with parent permission).
The information you submit from this form is safely transmitted in a manner that is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).