CONTACT US/ REQUEST A VISIT - Helping Us Grow (HUG)

Helping Us Grow (HUG)

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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 *

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

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