Directions for Completing Referral Form for Early Intervention Service Coordinators:

1. Please discuss the referral with the family, fill out questions on the form and have parent sign the release portion of the form.

2. The service coordinator will add the referral to the RCP to the IFSP.

3. The service coordinator will send the completed referral form and the developmental assessment to the RCP by fax or mail.

4. Once the information is received, the RCP coordinator will contact the EI Service Coordinator within 3-7 days to schedule the consultation with the family, and discuss the specific needs of the child and family.

5. The RCP consultant will meet with the child and parents and service coordinator at the child’s home or in a community setting.

6. After the first consultation, the service coordinator, RCP consultant and parent can determine whether more services and/or resources will be needed from the RCP.