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Healthy Families Arizona

Healthy Families Arizona (HFAz) is a free and voluntary home visitation program that serves pregnant women and families of newborns. HFAz is a prevention program dedicated to supporting families in their quest to be the best parents they can be. Program services are designed to strengthen families during the critical first years of a child’s life. Through its efforts to support and educate families, the program has shown to reduce incidences of child abuse and neglect, provide stability for at-risk families, and increase economic self-sufficiency.
It has grown a new generation of healthy families in Arizona.

Make a Referral Today!

If you are interested in services and meet the one of the following criteria listed below, then you or a provider can submit a referral to begin the process on your behalf. Parents must also have legal custody of their child(ren) within the first 90 days of services if accepted:

You are pregnant and/or
You have a child that is age 3 months old or less at the time of the submitted referral

If you meet one or both of the criteria above, please complete the form below.

Caregiver's First Name:

Caregiver's Last Name:

Caregiver's Email:

Caregiver's Phone Number:

Question for Caregiver: Are you pregnant?

Expected Due Date:

Caregiver Question: Do you have a child age 3 month's old or less?

Child's Name (1)

Child's DOB (1)

Child's Name (2)

Child's DOB (2)

Sorry, you do not qualify

For eligibility questions, please email [email protected].

Address

City/Town

State/Province

ZIP/Postal Code

Caregiver's County:

Maricopa County Residents: Select the option that contains your zip code

Option 1

85042, 85043, 85045, 85256, 85323, 85326, 85329, 85338, 85339, 85340, 85353, 85392, 85395, 85396

Option 2

85006, 85010, 85012, 85014, 85016, 85018, 85020, 85048, 85053, 85127, 85142, 85208, 85209, 85212, 85213, 85216, 85226, 85233, 85234, 85248, 85249, 85250, 85283, 85284, 85286, 85295, 85296, 85297, 85298

Option 3

85022, 85023, 85032

Option 4

85003, 85004, 85007, 85008, 85009, 85013, 85015, 85017, 85019, 85021, 85024, 85027, 85028, 85029, 85031, 85033, 85034, 85035, 85037, 85040, 85041, 85044, 85050, 85051, 85083, 85085, 85201, 85202, 85203, 85204, 85205, 85206, 85207, 85210, 85224, 85225, 85251, 85253, 85254, 85255, 85257, 85258

Option 5

85259, 85260, 85262, 85263, 85264, 85266, 85268, 85281, 85282, 85301, 85302, 85303, 85304, 85305, 85306, 85307, 85308, 85310, 85331, 85335, 85345, 85351, 85355, 85361, 85363, 85373, 85374, 85375, 85378, 85379, 85381, 85382, 85383, 85387, 85388

Pinal County Residents: Select the option that contains your zip code

Option 1

85117, 85118, 85119, 85120, 85140, 85144, 85173, 85178

Option 2

85122, 85123, 85128, 85130, 85131, 85132, 85138, 85139, 85141, 85143, 85148, 85172, 85193, 85194

Preferred Language:

Is this referral being submitted on behalf of the Caregiver?

Name of Provider submitting the referral:

Email of Provider:

I agree to the Release Authorization.

Release Authorization

By submission of this form, I/we authorize the Healthy Families Arizona to release the above information on a need-to-know basis to Healthy Families AZ service providers. Submission of this form indicates the caregiver is aware that a Healthy Families AZ referral is being submitted and the caregiver agrees to be contacted from a designated Healthy Families service provider and/or the Healthy Families AZ Coordinator.

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