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Lead and Healthy Homes Program Referral Form

  1. Contact Information

  2. Owner or Renter*

  3. Property Information

  4. Lansdale Borough or Pottstown Borough*

  5. Is this property currently vacant?*

  6. Is this a rental property?*

  7. Was this residence built before 1978?*

  8. Is there a pregnant woman that lives at this address?*

  9. Is there a child under 6 that currently resides at or regularly visits this address?*

  10. income

  11. Does your income fall below the limits listed above? -- For Landlords: Does your tenants' income fall below the limits listed above?*

  12. Leave This Blank:

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