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New Car Seat & Car Seat Check Requests

Please fill out the form below if you are in need of a new car seat OR if you need one of our Child Passenger Seat Technicians to check your current car seat or booster seat. You will receive a confirmation email after submitting and a staff member will reach out to you within 72 business hours.

​New Car Seat & Car Seat Check Request Form

Please complete this form only if you are requesting a car new seat or need a check or your current car seat or booster seat. If you need diapers, transportation, or any other request, please click here. A staff member will contact you within 72 business hours (this does not include weekends).

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Single?
Healthy Babies Client?
Healthy Start Client?
Preferred Method of Contact
What other agencies are you accessing?
Do you own a vehicle?
Are you using public transportation?
Can you safely travel to us to receive the car seat or car seat check?
Is the child already using a car seat?
Please select the following (you may choose more than one):

Please Note: This information is strictly confidential and any personal information will not be shared.

Thanks for submitting! We have received your request.

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