This online referral form is for anyone who is looking to connect a
pregnant woman to resources through the My Healthy Baby program.
We encourage you to speak with the pregnant woman about this
referral so she can be prepared to answer a call from the
Indiana Department of Health when we contact her about My
Healthy Baby.
Following submission of this referral, My Healthy Baby will attempt to call the referred individual. A referral can be revoked at any time by calling 844-624-6667.