Registration Form

The Rhode Island Department of Health (RIDOH) is working to improve the services available to families with young children in your area.

Thank you for your interest and availabity for participating in a family focus group on Family Visiting.

Family Visiting offers free, voluntary programs that support parents from pregnancy through early childhood by connecting them with helpful information, resources, and regular check-ins from trained staff.

Whether you’ve used Family Visiting before, heard about it, or never even knew it existed, we want to hear from you!

To register for a focus group, please provide the following information.
Your information will be kept confidential and will not be shared for any other purpose.

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* 1. Name

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* 3. Phone

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* 4. Address

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* 5. What age(s) are your child(ren)? Check all that apply.

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* 6. Which of the following best describes your relationship to the children in your household?

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* 7. Have you heard of “Family Visiting” programs before today?

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* 8. Are you able to attend the upcoming online focus group? (We are looking for 6-10 participants for a 1 hour session.)

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* 9. Will you need Spanish interpretation to participate in the focus group?

THANK YOU

Thank you for taking the time to register for our focus group on Family Visiting.
Your participation and feedback is important to us.
To show our appreciation, each focus group participant will be given a $30 gift card.

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