Skip to main content
Workshops
CCHC Registry
FAQS
Contact
Sign Up
Log in
Sign Up
Log in
Child Care Health Consultant Inquiry Form
You have not chosen a consultant to contact.
Contact Name
Contact Phone Number
Contact Email
Preferred Method of Communication
Email
Phone
Text Message
Preferred Contact Hours
Organization
If this does not apply to you, please put N/A.
Type of Child Care Provider
Type of Child Care Provider
- Select -
Family, Friend, and Neighbor
Head Start & ECEAP Program
Licensed Child Care Center
Licensed Family Home Child Care
License-Exempt Part Day Preschool
Other
Enter other…
Type of Service Needed
You can select more than one service type.
Behavior Consultation
Child-specific Observation
Child-to-caregiver Relationship
Classroom Observation
Community Resources & Referrals
Comprehensive Developmental Evaluation
CPR & First Aid Training
Developmental Disabilities or Delays Consultation
Developmental Screening
Health and Safety Assessment
Health Policy Review
Hearing Screening
Infant and Early Childhood Mental Health Consultation
Infant Room Nurse Consultation (Monthly)
Medication & Care Plan Review
Nutrition Consultation
Resources and Support for Child Evaluation / Diagnosis
Staff and Caregiver Health and Wellness
STARS-eligible trainings
Trauma-informed Care
Vision Screening
Other
Other Service
Please expand more on your needs
Please do not include personally identifiable information about children in your care in this section.
How many infant rooms does your child care have?
Mode of Service
Virtual (i.e. Phone Call, Email, Video Call)
Hybrid
In-person
Address Where Service is Needed At
Preferred Service Hours
Any additional details you'd like to add?
Submit