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2. Public Health Referral / Request for Information
   
   

   Use this form to request information or services offered by Meeker County Public Health. 

4. Parent First Name*
5. Parent Last Name*
6. Date of Birth*
   Date of Birth
8. Child's First Name
9. Child's Last Name
10. Child's Date of Birth
    Child's Date of Birth
12. Address1*
14. Address2
16. City*
17. State*
18. Zip*
20. Phone Number*
21. Best Time to Contact
23. Interpreter Needed? *

    1. Yes

    1. No
25. Okay to make initial contact via text?*

    1. Yes

    1. No
27. Reason for referral (please check box):
29. Parents as Teachers

    1. Parents as Teachers

    A free parent support program for families with children 0-5 years of age. The program helps you understand your child's development, be more involved in your child's education, connect to your child through play ad reading time and to be confident in your role as a parent. 

    PH-PAT-flyer-updated-10725 

30. WIC

    1. WIC

    WE provide supplemental foods, tailored nutrition/breastfeeding education to pregnant or postpartum women, infants and children under age 5. Let us check to see if you are eligible. 

    WIC Program - MN Dept. of Health

32. Project Harmony

    1. Project Harmony

    Free, voluntary support for pregnant and parenting women working toward recovery from substance use. Public Health Nurses and Peer Recovery Specialists help reduce barriers to sobriety, support healthy parenting, connect families to community resources, and assist with emergency needs like childcare, transportation, or housing. This program serves women who are pregnant and/or parenting young children (birth to early childhood) in Meeker, McLeod, and Sibley Counties.

    Project Harmony - Meeker McLeod Sibley Community Health Services 

33. Healthy Homes

    1. Healthy Homes

    A free service helping families identify and reduce common home health hazards so you and your loved ones can live in a safer, healthier environment. Healthy Homes focuses on practical ways to improve indoor air quality, reduce moisture and mold, prevent pest and chemical exposures (like lead, radon, carbon monoxide, and VOCs), and increase overall home safety and comfort. Public Health staff can assess your home based on recognized healthy home principles and connect you with resources, guidance, and strategies to address concerns and protect your family’s health. 

    Healthy Homes Minnesota - MN Dept. of Health

35. Family Home Visiting

    1. Family Home Visiting

    A free, voluntary program where Public Health Nurses provide in-home support for parents and babies. Services include breastfeeding support, baby weight checks, safety checks, parenting education, and help connecting to healthcare and community resources—offered on your schedule in a supportive, judgment-free way.

    https://www.co.meeker.mn.us/215/Family-Health 

36. Car Seat Program

    1. Car Seat Program

    Free child passenger safety support to help families keep kids safe on the road. Public Health offers free car seat safety checks by certified technicians for families with children of all ages, including car seat installation guidance, recall status checks, explanation of current laws, and hands-on training to ensure seats are used correctly. Families may also be eligible for a free car seat.

    Car Seat Safety | Meeker County, MN - Official Website  

38. I would like more information about...
40. Contact Us

    For assistance with this form or for any questions please contact Meeker County Health & Human Services at 320-693-5300 or public.health@co.meeker.mn.us

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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

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