Women and Infant Health Program Material Request Form
Please fill out the form below to request materials from the Wyoming Department of Health-Maternal and Child Health Unit's Women and Infant Health Program.

Please contact natalie.hudanick1@wyo.gov if you have any questions, comments, or any funding needs outside of the listed materials!
Sign in to Google to save your progress. Learn more
Name *
What is your organization? *
County *
Mailing Address (full mailing address and who to send the materials to please! Not just the street) *
Email Address *
Charlie Kids Sleep Baby Safe and Snug Books (Can Order up to 60 books)
Captionless Image
Clear selection
If you would like the Charlie Kids Sleep Baby Safe and Snug Book in Spanish, how many would you like? PLEASE REQUEST IN ORDERS OF 10
Pack N Plays to give out to clients/patients/parents as an emergency safe sleep option
Clear selection
CDC Hear Her Magnets (the image is what is on the magnets, but they will be 5 x 7) - PLEASE REQUEST IN ORDERS OF 10
Captionless Image
If you would like the magnets in Spanish, how many would you like? PLEASE REQUEST IN ORDERS OF 5
Maternal Mental Health Hotline Cards (wallet size cards) - PLEASE REQUEST IN ORDERS OF 50

to see what the cards look like, please click on the link above. 
If you would like the wallet cards in Spanish, how many would you like? - PLEASE REQUEST IN ORDERS OF 25
If you have any other funding needs related to women's wellness visits, smoking cessation during pregnancy, and/or safe sleep, please describe these needs below! We will contact you based on these needs to figure out how we can help! 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of State of Wyoming. Report Abuse
Google Forms