Directions for Completing a Referral Form for Child Care Providers or Child Care Resource and Referral Agencies

1. Discuss the consultation referral with the parent. The parent must agree with the provider regarding the need for a consultation.

2. The child must be enrolled in an Early Intervention Program in order to receive RCP services. The RCP staff can assist the childcare staff or parent in enrolling in an Early Intervention Program.

3. Complete all questions on the referral form and send or fax to: The Regional Consultation Program, 500 Victory Road, Quincy, MA 02171. Fax: 617-847-0915