Refer a Child
NYC Early Intervention (EI) Program Referral Form
This is the official New York City Early Intervention Program (EIP) Referral Form. It is used to refer a child who may have a suspected or known developmental delay or disability, or a child who is typically developing but may be “at risk” for atypical development (Developmental Monitoring). Anyone can make a referral by filling out this form.
Completing this form is the first step to connect a child to early intervention services. Please note that Early Intervention is confidential, and certain sections of the form require informed parent/guardian consent before information can be transmitted or shared.
