Early Intervention Referral Form

Families, Doctors, and community members can make a referral by:

  • Calling 311 and asking for Early Intervention
  • Printing and filling out the referral form (PDF) and faxing it to the Regional Office in the child’s borough

Employees of the Administration for Children’s Services (ACS) or agencies contracted with ACS must call the Citywide ACS Referral Hotline at:
877-885-KIDZ (5439) to make a referral to the Early Intervention Program.

All Early Intervention Providers must make referrals through the New York Early Intervention System (NYEIS).

Learn more about the Early Intervention Program.