HealthySteps Site Interest Form and Letter of Intent

HealthySteps partners with organizations that provide well-child visits to children ages 0-3.

Interested in bringing HealthySteps to your Los Angeles County community? Complete this form and upload a letter of intent. The HealthySteps National Office at ZERO TO THREE will review your interest and invite the appropriate applicants to submit a proposal.

If you are not a health system, nor looking to partner with a health system, please feel free to contact us directly at healthysteps@zerotothree.org and we’ll be in touch.

Complete the contact information for the individual slated to lead the proposal effort.

First Name

Last Name

Your Pronouns

Organization

Title

Telephone Number

Email Address

Please provide information about your prospective HealthySteps site(s).

Name of Practice/Health System/Organization (if different than previous page)

Website

Practice Telephone

Country
For international inquires, please select 'Other' here and from the State field below.

Mailing Address

City

State

Zip Code

Please select the response that best describes the primary setting of your practice(s). (Choose only one)

Other - please specify

Approximately how many children ages 0-3 are seen at your practice(s) annually?

Please share any information about the community(ies) you serve, e.g., population demographics, most common insurance types (public vs. private), languages spoken, etc.

Please share any other information about your practice(s) that you would like us to know.

How did you hear about HealthySteps?

Please upload your Letter of Intent as a PDF.