Thank you to our Bow Ties and Tiaras 2024 Sponsors:
Schwartz Family Charitable Trust
Pediatrix Neonatology
District 1 Medical Examiners Office
HCA Florida West
Ascension Sacred Heart
Morette Company
Nemours Children's Health
Dr. Danielle and Raife Armstrong
Baptist Healthcare
Kim and Ray Blackburn
Emmanuel, Sheppard, & Condon
Dr. Frank and Margot Lauro
Lorraine Lopez Morell
Dr. Deanna Oleske
Peacock Wealth Management Team | Edward Jones
Robin and Joseph Wright
Referrals
What are referrals?
Healthy Start referrals are voluntary screening tool that allows our Healthy Start Coalition to reach out to additional moms, dads, and babies that may be at risk for poor birth or developmental outcomes.Â
Who can fill out a referral?
Any member of the community who has obtained consent from the person being referred can fill out the referral form. This includes but is not limited to:
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Pediatric offices
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OB/GYNs
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The Department of Children and Families (DCF)
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Social workers or mental health providers
Please note we are not able to contact anyone who is currently incarcerated.
How do I send in a referral?
The electronic form found above is preferred.
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If you are unable to complete the form, please see the downloadable PDF below.
Referrals should be faxed to (850) 696-2551.
If you are unable to fax, please send the email to referrals@healthystart.info using an encrypted or other secure messaging system.
How should I fill out the PDF referral form?
All required information is highlighted. Please make sure to include all information or we will not be able to properly process the referral.
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Special Cases:
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For infants: the infant's name, DOB, gender, address, and phone number should be included under "Client Information." And mother's information should be included in the "Parent/Guardian" section.
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If the child is not in the care of the mother, and you are referring the infant: the infant's name, DOB, gender, address, and phone number should be included under "Client Information." And guardian's information should be included in the "Parent/Guardian" section.
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If the child is not in the care of the mother, and you are referring the mother: the patient being referred would be marked as "mother without infant who is less than 18 months postpartum," and mother's information would be included in the client information.
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For incarcerated people: we are not able to contact anyone who is currently incarcerated.