Test Request form safe start

The Safe Start program is for women who are admitted to your maternity unit after the birth of their baby and it has been identified that they don't have the basic items to care for their baby once discharged.

Please note that orders placed before 10am may be distributed the same day if stock is available but delivery cannot be guaranteed.  

If you are not yet registered, please register here before completing this form.

 

example: 0744445555

Note - If the family needs two car restraints please detail this in notes below.

Does the family understand that for future material aid that they will need to access St Kilda Mums via a social worker or Maternal Child Health Nurse? (If they are not supported by another agency please link them into their local Maternal & Child Health Centre)*