Health Referral Form

Please use this form to refer clients within your organization to our health classes and child wellness programs! Before continuing, please ensure that your client meets our requirements for the services we are offering. The client must be a female of refugee/immigrant status of the United States, reside ideally within New Haven County or within the state of Connecticut, and must predominantly speak Arabic, Pashto, Dari, or Farsi.

Referee's Information

Student's Contact Information