Healthy Families Steuben/Livingston staff strive to talk with all expectant parents and parents of newborns in the communities we serve. Our goal is to identify strengths and challenges prenatally or at birth and provide appropriate information and referrals to help babies get off to a healthy start. Healthy Families services are always free and voluntary and your information and privacy is always protected and respected.

If you are pregnant or have a baby under three months and are interested in learning more about the program, please complete the survey below and a staff member will contact you.  

For additional information on the program, please email healthy.families@dor.org or visit www.ccsteubenlivingston.org and/or www.healthyfamiliesnewyork.org

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* 1. What is today's date?

Date

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* 2. Expectant/new mother's first and last name

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* 3. Expectant/new mother's support person

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* 4. Expectant/new mother's date of birth

Date

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* 5. Contact Information

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* 6. What is the best way to contact you?  (check all that apply)

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* 7. Due date or birthday of your baby

Date

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* 8. When did you start receiving prenatal care?

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* 9. Relationship status

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* 10. Do you have financial / money concerns?

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* 11. Are you receiving WIC, SNAP, Medicaid/Fidelis or any other NYS benefits?

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* 12. How did you hear about us?

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