BRHF Referral Form

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BRHF Referral Form

Thank you for accessing our electronic referral form. Once your referral is received, we will send you a confirmation email that we received it. If you are unsure of any information below, please indicate that with "unknown". This referral should take less than 10 minutes complete. All questions and concerns can be emailed to autumn.syder@brhealthfamilies.org.

Helping families understand our program is a major component to their willingness to enroll and their success in the program. Please, if possible, take a moment to explain the program clearly and efficiently to families.

Below is a guided script that we have created for your ease and benefit while explaining BRHF.

"Blue Ridge Healthy Families is a free and voluntary home visiting program. A trained home-visitor will come to you, even if meeting outside of the home is necessary. They provide critical support that is individualized to you and the needs of your family. Would you be willing to let me send them a referral on your behalf in order for one of their staff to call you and answer any questions you may have?"

Thank you from the BRHF Team

*Positive referrals will be prioritized based on risk, gestation, and/or staff availability.

Email *

What agency are you referring from? *

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