Healthy Moms, Healthy Babies of Mississippi: Program Referrals

Healthcare Provider Referrals

Online form

• Maternal/Infant Referral Form for healthcare providers

Printable Forms

Please send referrals by fax or e-mail (see contact details below).

• Infant Screening/Referral Form for healthcare providers PDF
• Maternity Screening Form for healthcare providers PDF

Non-Medical Referral

• Online form for non-medical referral
• Printable form for non-medical agency referral PDF

Contact Us About Referral

Want more information about the program, or to see whether you are eligible?

• Call: 601‑576‑7113
• Fax: 601‑576‑7825
• E-mail: HM.HB@msdh.ms.gov

Referral Services

• Bereavement / Grief Services Mississippi SIDS Alliance
• MSDH Early Intervention Program
• Child Abuse Hotline MDCPS