The information you provide on this survey will help our Child Passenger Safety technicians schedule your car seat check appointment.  By understanding your needs and unique situation, we will be better prepared to help answer all of your questions.  
We value your privacy, and will not share or sell any of your information.  

Please note: with a few exceptions, all of our installation appointments occur on the 4th Thursday of the month between 8 a.m. and 3 p.m. If you are not available on Thursdays, please email the address below, and we will do our best to arrange for an alternative date, or technician, to help you.
Also, if you have any trouble submitting this survey please email rdysico@sarpycasshealth.com
Thank you and remember to buckle up!

Question Title

* 1. Please enter the best contact information for us to use when scheduling appointments

Question Title

* 2. Do you receive state or federal aid and are in need of a car seat?  Some examples are Medicaid, WIC, SNAP

Question Title

* 3. How did you hear about our car seat program?

T