You will need to provide the following information to make a referral to Infant and Toddler Connection:
- Name and telephone number of person making the referral.
- Child’s name, gender and date of birth.
- Language spoken by the family/primary caregiver.
- Name, address, and telephone number of the parent or legal guardian.
- Reason for referral (child has suspected or confirmed developmental delay or disability).
- 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.
- Health insurance name (to include Medicaid), policy number and other insurance information, if applicable.