Parents as Teachers Referral Form
Parents as Teachers (PAT) is available and free to any family in Montgomery County with children under 6 years old. If you would prefer to give us information by email or phone, please email pat@fsmontco.org or call 610-326-1610 ext. 327.

PAT is a program of Family Services of Montgomery County. For more information on Family Services, visit www.fsmontco.org or email info@fsmontco.org.

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Caregiver interested in program (First & Last Name): *
Address: *
Best Phone Number to call: *
Best time of day to call:
E-mail: *
Family's primary language: *
Ages of children under 6 years old: *
How did you hear about Parents as Teachers?
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If you have any questions about the program, please list them here (Not Required):
If you filled this form out for someone other than yourself, please list your name and relationship to the family:
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