Fill out our online form – for fastest response
This is the quickest and easiest way to submit a referral for a Birth to Three. Please select the referral form that best matches your relationship to the child.
If you receive an error message when submitting the form, please contact 211 Child Development at 1-800-505-7000 for assistance. Their team is available Monday through Friday, from 8:00 AM to 6:00 PM EST.
You can also fax a referral to 860-571-6823 using the approved referral form located here. Please do not send any additional paperwork beyond the CT Birth to Three Referral Form.
Parent/Guardian/Foster Parent Referral Form
DCF Referral Form
If there are no concerns with the child’s development, use this developmental screening form instead.
Referral Form for Others
Such as teachers, child care providers, health care providers, friends, and relatives to name a few.