Quinnipiack Valley Health District - Mom's Clinic Online Application Request Form

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Mom's Clinic - Application Request Form

Mom's Clinic is a school Based Health Center at Hamden High, 203.248.6107. It is a licensed outpatient clinic and provides a full array services. Mom's Clinic is operated by the Quinnipiack Valley Health District, and supported through a grant from the State of Connecticut.

Mom's Clinic is grant funded, and is not funded by local tax or Board of Education funds.

To enroll a child in Mom's Clinic, all parents must complete and sign a registration form. To request a form be sent by mail call 203.248.4528 or fill out the request form below.

Request Form

Name

(R)

Email

Phone

Address: (R)
Address 1
Address 2
City
State ZIP

(R) = Required

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Quinnipiack Valley Health District 1151 Hartford Turnpike North Haven, CT 06473	Phone. (203)248-4528 Fax. (203)248-6671 E-Mail. info@qvhd.org

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