Make a Referral
Who can refer?
Parents don’t have to wait for a referral to early intervention. If you’re concerned about your child’s development, you may contact
1-800- 505-7000 and ask to have your child evaluated. That evaluation is provided free of charge.
If you are not the parent or guardian you may make a referral anytime, but please speak with the family first. We will contact them for their permission to proceed with your referral, and they may accept or decline. For more information or to refer a family who may need help with their child’s development call Birth to Three System 1-800-505-7000
Print and Fax this form to 860-571-6853