Referrals

Check Our Referral Process

Referral Process

Getting started with First Steps is an easy process that begins with a phone call to the Systems Point of Entry (SPOE) office 1 (800) 387-7837 or by completing the online referral form. Once a referral is received, a Service Coordinator will contact the family within two business days.

At that time, he/she will talk to the family about the First Steps program and the developmental concerns they may have for their child. He/she will schedule our Assessment Team (AT) to conduct an assessment at no cost to the family in the child’s home at a time convenient for the family.

The Assessment Team, which consists of trained early intervention therapists, will evaluate the child in all developmental areas to determine whether First Steps services are warranted.

To make a referral to your local First Steps office, please click the area you live

Is your child over the age of 3?*
Indiana First Steps is only able to serve children until their 3rd birthday. Please contact your local public school for additional services for children over 3.
County*
Child's First and Last Name*
First
Date of Birth*
MM slash DD slash YYYY
Male/Female
Parents/Guardians Name*
Address
City
Zip Code
ZIP / Postal Code
Home Phone*
Cell Phone
Email*
Text Yes/No
Your Name (Person making the referral)
Your Phone
Relationship to Child
How did you hear about us?
Reason for the Referral*
Child's Race*
- American Indian or Alaska Native
- Asian
- Black or African American
- Hispanic/Latino
- Native Hawaiian or Other Pacific Islander
- White
- Unknown
Ethnicity*
Primary Language*
If the child has a medical diagnosis/ICD-10 code, please list here:
Doctor’s Name
Doctor’s Phone
Doctor’s Fax
Doctor’s Address
Doctor’s City
Doctor’s Zip Code
ZIP / Postal Code
Comments
Email address if you would like a copy of your referral
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Referrals

Check Our Referral Process

Referral Process

To make a referral to your local First Steps office, please click the area you live

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