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TextInformation Needed for Infant & Toddler Connection of Fairfax-Falls Church Services
You will need to provide
the following information to make a referral to Infant and Toddler of
Fairfax-Falls Church (ITC):
- Name and telephone number of person making the referral
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- Child’s name, gender, and date of birth
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- Language spoken by the family/primary caregiver
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- Name, address, and telephone number of the parent or legal guardian
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- Reason for referral (child has suspected or confirmed developmental delay or disability)
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- Health and physical information, including vision and hearing evaluations, results of any neurological and/or developmental evaluations and any other information pertinent to the child’s physical and developmental status and needs
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- Health insurance name (to include Medicaid), policy number, and other insurance information if applicable
More Information
Who might be eligible for services through Infant and Toddler of Fairfax-Falls Church (ITC)?
What services does Infant and Toddler of Fairfax-Falls Church (ITC) provide?
What is the cost of Infant and Toddler of Fairfax-Falls Church (ITC) services?
Our referrals page includes physician referral forms and other information on the ITC referral process.
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