Are you pregnant and 36 weeks gestation or less?
Are you a current tobacco user, quit since becoming pregnant, or quit within 3 months of becoming pregnant?
If either answer is 'No', you are not eligible to enroll in the BABY & ME-Tobacco Free Program.
For more information please
Date of Birth
Estimated Due Date
Please check the boxes below:
I attest that the information provided about me in this referral (i.e.- eligibility and personal information) is correct, accurate, and complete.
I agree to having my personal information shared with the South Carolina BABY & ME-Tobacco Free Program.
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