Let's learn more about your program.
Every Head Start and Early Head Start program is different. This short questionnaire will help me understand your program, the challenges affecting your health component, and the type of support that may be most useful.
You do not need to have everything figured out before we meet. The purpose of our consultation is to identify your priorities and discuss practical next steps.
Please do not include children's names, family names, medical records, screening results, protected health information, or other confidential child, family, or staff information in this form.
Estimated completion time: 5–7 minutes.
