CCHC Car Seat Program

Welcome to the Carter County Health Center Car Seat Program Request Form!!


We are committed to helping families keep their children safe on the road. If you are in need of a car seat or would like to schedule a car seat check with one of our certified technicians, please complete this form.


Our staff will review your request and contact you to schedule an appointment. Please note that availability may vary based on eligibility, need, and inventory.


For more information on proper car seat use and safety guidelines, visit the National Highway Traffic Safety Administration (NHTSA) Parents Central website.

 

This will be used to confirm receipt of your request.

 
 
 

Please enter the First and Last name of the parent or guardian

 

Car seats are provided based on availability. Priority is given to families who participate in one or more of the following assistance programs. While participation in these programs is not required, it helps us determine eligibility when supplies are limited.

 

This will be used to set an appointment with one of our certified car seat technicians.