Click the image below for the UPDATED Fax referral form, posted on 09/07/16. Scroll to page 2 to add optional information to the referral form, and scroll to page 3 for simple instructions. You can print the instructions first, if that helps. Please remember to print the completed form and fax it to SEAS.

Scroll farther down for a tool for sharing child specific information with a Primary Care Provider.


If you are not a Primary Care Provider (PCP) and you have concerns about a child, you can use the form below to communicate your concerns to the PCP. The PCP may then want to refer the child for a GIDES evaluation or for Specialty Therapy Services.


Child Specific Information for PCP e form 2016-07-20






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