Maternal & Infant Health Services Provided Section
Does your organization directly provide any of the following classes/training?
Does your organization directly provide any of the following supplies?
Limited supplies of diapers, wipes, and manual breast pumps.
Does your organization provide any of the following direct services?
If you offer support groups, what type of support groups do you offer?
Peer mentorship for NICU or bereaved families
Additional Requirements Section
Does your organization provide any of the following Tele-services?
Does your organization provide any of the following forms of transportation assistance?
Gas and Rideshare Compensation in limited supply
Referral Process: Do you need to be referred to receive services?
If Yes, please describe the referral process?
Send an email to email@example.com with name and contact information of family.
Is government-issued identification required to receive services? If yes, what form of ID do you require?
Payments: Which form of payments does your organization accept?
Are there additional criteria for clients to receive services?
Have a baby in the NICU in Louisiana or have lost a baby in Louisiana
Is there public transportation available with one mile of your company/agency? (Does the city bus route have a stop within walking distance?)