Healthy Families Rappahannock Area Questionnaire
Healthy Families is a living breathing manual that offers a nationally accredited program that provides the tools, guidance and support that families need to build a healthy, successful life. We provide free services in the localities of Caroline, Fredericksburg City, King George, Stafford, and Spotsylvania. Once a family is enrolled, a family support specialist provides regular home visits from pregnancy until child reaches the age of 3 or 4 so they can learn how to recognize and respond to their babies’ changing developmental needs, use positive discipline techniques, cope with the day-to-day stress of parenting in healthy ways, and set and achieve family goals.
The first five questions are required. To be able to submit this questionnaire, please answer the first five questions even if you are not interested in receiving services. You will not be contacted if you select "I do not wish to be contacted" below, your responses will only be used for statistical purposes. Thank you!
I have received information on Healthy Families and:
I am interested in resources (Items for baby and/or family) and Information (about additional resources)
I am interested in receiving support from a Family Support Specialist.
I do not wish to be contacted. (Please complete the 3 required questions below)
I am completing this survey:
I live in:
Date of Birth
My preferred method to be contacted is:
My babies father's name is:
His date of birth is:
My baby's name:
Please enter your baby's DOB or expected DOB
My first prenatal visit was between
None prior to delivery
I am currently:
Working full time
Working part time
Looking for a job
College, vocational or technical student
High school student
My income is sufficient to meet my needs
I currently receive the following assistance:
None of the above
Is your family (including the father of the baby) happy and supportive of this pregnancy?
Right now I feel (check all that apply):
Send me a copy of my responses.
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