Referral to Early Intervention or Early Childhood Special Education Services in Clackamas County

This referral form is designed for community providers to submit referrals when they have a concern with a child's development (such as preschool providers, childcare, home visiting providers). If you are a medical provider, please use the Physician Referral link on our website to access the Universal Referral Form.

If you are a parent, resource parent, or guardian referring your child, please use the Parent/Guardian Referral Form.

Please make a referral with the knowledge and permission of a parent. We cannot share information with you about the status of a referral without a signed Release of Information (ROI). If you want to download an ROI for signature before moving forward with this referral, you can access a pdf form here: ROI for Evaluation

Please complete this referral as completely as you are able. You will have the opportunity to upload screenings or other pertinent documents, such as the ROI, at the end of this form.