Maternal and Child Health Key Age and Stage (KAS) visits

Please complete this form to request an appointment with a Maternal and Child Health (MCH) nurse at a centre near your home.

You can request an appointment with a nurse to check your child's health and growth at key stages listed below. Remember to bring your child’s green book to each visit.

Due to a shortage of nurses, high local birth rates along with the impact of COVID-19, we currently have limited appointments and need to prioritise our newborns and vulnerable infants.

Please allow five business days for the MCH team to review your form and get back to you.

For urgent concerns, please contact the Victorian Maternal and Child Health Line at 13 22 29.

Privacy Statement

Your personal information and that of the child is being collected by Council to enable book/change/cancel your MCH appointment. Your/and the child’s personal information will be used and stored by Council to administer and schedule appointments and used to identify you when communicating with Council. For further information about how your personal information is handled, refer to Council’s Privacy Policy.

I have read and understood the Privacy Statement mentioned above (required)

Who is the appointment for

Provide your Child’s First name (required)

Provide your Child’s surname (required)

Date of Birth (dd/mm/yyyy) (required)

Gender (required)

Female

Male

Other

Contact info

Provide your first name (required)

Provide your surname

Phone Number (required)

Email (required)

Are you a new resident of Wyndham?

Yes

No

Current Address (required)

Provide previous address if moved since last MCH appointment

Relationship to child (required)

Mother

Father

Carer

Are you the primary carer of the child? (required)

Yes

No

Primary Carer Detail

I am (required)

I am the primary carer of the child

I am not the primary carer of the child

Mother's Details

Mother’s First Name

Mother’s Surname

Mother’s Date of Birth (dd/mm/yyyy)

Any further comments

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Acknowledgement of Traditional Custodians

Wyndham City Council recognises Aboriginal and Torres Strait Islander peoples as the first Peoples of Australia. We acknowledge the Bunurong and Wadawurrung Peoples as Traditional Owners of the lands on which Wyndham City operates. The Wadawurrung and Bunurong Peoples have and always will belong to the Werribee Yalook (river), creeks, stars, hills and red clay of this Country. We pay respect to their Ancestors and Elders who always have, and always will, care for Country and community today and for future generations.