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Healthy Neighborhoods Program (HNP)

  1. Do you rent or own your residence?*
  2. Age(s) of persons in the residence*

    Please select all that apply.

  3. Does anyone in the residence have asthma?
  4. Does anyone in the residence smoke?
  5. Is anyone in the residence currently pregnant or planning to become pregnant?
  6. Do you have functioning smoke detectors?
  7. Do you have functioning carbon monoxide detectors?
  8. Thank you for filling out this form. A staff member from the Cayuga County Healthy Neighborhoods Program (HNP) will be contacting you soon to setup your no-cost home assessment.

  9. Leave This Blank:

  10. This field is not part of the form submission.