Perinatal Care Packages

Free perinatal care package for pregnant and postpartum birth givers provided by Pickles and Ice Cream, a project of HMHBGA

Perinatal Care Package Demand Tracking (THIS IS NOT AN ORDER FORM)

The Perinatal Care Package Order Form has been closed. This is a notification form so that we understand the demand of families and email you once the order form reopens.

Name

First Name

Last Name

Email

DESIRED NUMBER OF PACKAGES IF THE FORM WAS OPEN (LIMIT IS 10 FOR ORGANIZATIONS/PER LOCATION)

The Perinatal Care Package Order Forms are closed and will reopen on the 1st of the month. This is a notification form so that we understand the demand of families for care packages, and we will email you once the order form reopens. This is NOT an order form. You are requesting us to contact you once the form reopens by completing this demand form.

Consent

I understand by completing this Demand Tracking Form that a Healthy Mothers, Healthy Babies Coalition of Georgia representative will contact me by email once the prenatal and postpartum care package forms reopen. I understand that this is NOT an order form, and I will NOT receive care packages on the basis of this form.

I AGREE TO BE NOTIFIED WHEN THE PERINATAL FORMS REOPEN.

Fathers Matter ATL

Georgia Department of Humans Services' Fatherhood Program