Schedule a Visit

2. Home Lead Risk Assessment

   The Cayuga County Health Department offers FREE home lead risk assessment services for renters and home owners living in Cayuga County who reside in older homes and have children under 6 years of age.

   If you are interested in having your home assessed to identify any lead hazards present, please fill out this form. A Cayuga County Health Department representative will contact you soon.

4. Name
6. Phone Number
8. Address
10. City
11. State
12. Zip Code
14. Type of Home

    1. Own
    2. Rent
16. Number of Children Residing in Home
    -- Select One --1234 or more
18. Ages of Children

    1. 0 - 11 months old
    2. 12 - 23 months old
    3. 2 years old
    4. 3 years old
    5. 4 years old
    6. 5 years old
    7. 6 years old

    Select all that apply

Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field