CONTACT US/ REQUEST A VISIT

HOME
CONTACT US/ REQUEST A VISIT
HUG You Tube Video
HUG PARTNERS
RESOURCES
IN THE NEWS ...
PARTNERS ONLY
PROVIDER MEETING MINUTES
BROOKLYN CENTER AND ROBBINSDALE SCHOOL DISTRICTS FLYERS
COMMUNITY EVENTS
EDEN PRAIRIE SCHOOL DISTRICT FLYERS
THE DIAPER DRIVE
HOPKINS SCHOOL DISTRICT FLYERS

Please complete the form fields and someone will contact you to answer your questions, set up a home visit or respond to your diaper request.. Please note your address and phone are required.

* Indicates required field

Name *

First

Last

Email *

PHONE NUMBER *

Street address *

Apartment # *

City *

Baby's Date of Birth or Due Date *

Zip *

Reason for inquiry: *

I would like to set up a home visit I have some questions about a home visit or HUG Other (please list in comments section) I would like to request diapers or pullups -- please check sizes needed below and date for pick up

Please check all appropriate boxes

Preferred home visit times: *

Mornings Afternoons Other (add in comments box)

Select Diaper Sizes Needed: *

Newborn Size 1 Size 2 Size 3 Size 4 Size 5 Size 6 Size 7

Select Pull up Sizes Needed: *

2t3t 3t4t 4t5t

Comment *

Date you would like to pick up your diapers or pull ups (please select from the date options provided. If needed, add in the comments section any barriers to picking up diapers and someone will contact you.) *

Thursday, February 22nd 1:00 - 4:00 Tuesday, February 27 9:30 - 3:00 Tuesday, March 5th 9:30 - 3:00 Thursday, March 7th 1:00 - 4:00

OTHER DATE NEEDED, IF POSSIBLE: *

If not self referral, please enter name of person completing referral. *

If not self referral, please enter your email address and phone *

Did parent approve or request your assistance with a referral to HUG? *

Yes No They first would like more information about HUG

Submit

5440 Highway 169 Service Road New Hope, MN 55428
[email protected] 763-504-4983 / 763-504-4985 (fax) Spanish Line: 763-504-8985