Please take this quick survey | Family Health Initiatives

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First Name

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Last Name

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Mobile Number

What services were you referred to?*

(Please check all that apply.)

Breastfeeding Help/Support
Child Care
DCP&P or DYFS
Child Development Screening/Program
Doula Care
Fatherhood Services
Food Stamps
Housing Assistance
Mental Health Counseling
NJ Family Care, Medicaid, or other Health Insurance
Postpartum Care
Prenatal Care
Primary Medical Care for your Child
Primary Medical Care for Yourself
Help to Cut Down or Quit Smoking
A specialist to help you decide if you need to make changes in your drug and/or alcohol use
An expert of special program to help you cut down or stop using drugs and/or alcohol
TANF or Board of Social Services
Transportation
WIC

Were you able to reach the referral that you were given for breastfeeding help/support?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for child care?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for DCP&P or DYFS?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for child development screening/program?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for Doula Care?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for fatherhood services?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for food stamps?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for housing assistance?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for mental health counseling?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for NJ Family Care, Medicaid, or other health insurance?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for postpartum care?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for prenatal care?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for primary medical care for your child?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you ere given for primary medical care for yourself?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for help to cut down or quit smoking?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for a specialist to help you decide if you need to make changes in your drug and/or alcohol use?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for An expert of special program to help you cut down or stop using drugs and/or alcohol?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for TANF or Board of Social Services?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for transportation?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Were you able to reach the referral that you were given for WIC?*

I called them and got the service I needed.
I called them and they did not have what I needed.
I called them and I was not eligible for their service.
I called them, left a message, and they didn't call me back.

Please complete the following to the best of your ability