HANDS Information/Enrollment

Please Check All That Apply

First Time Mom

First Time Dad

Multigravida (given birth more than once)

Mom's Name

Email

Street Address

City

State

Dad's Name

Mom's Date of Birth

Phone

Alternate Phone

Can we send text messages to your phone number?

Yes

No

Zip Code

Due Date/Birth Date

County of Residence

Referred By (optional)

Referrers Phone Number (optional)

Comments (optional)

502-543-2415 or 502-955-7837

181 Lees Valley Road

Shepherdsville, KY 40165

Monday

Tuesday
Wednesday
Thursday

Friday

7:30 AM - 4:30 PM

7:30 AM - 6:30 PM

7:30 AM - 4:30 PM

7;30 AM - 11:00 AM

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