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Jefferson County Health Department

In need of a safe sleep place for your child? Complete this survey, and someone from our team will be in touch.

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* 1. Are you a Jefferson County Resident?

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* 2. Please list your full name.

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* 3. Are you WIC or Medicaid eligible?

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* 4. Which best describes you?

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* 5. What is or will be the baby's sleeping location?

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* 6. Please provide your email and phone number to be contacted.

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