Early Intervention Program Referral Form
for Children At-Risk or Suspected of Developmental Delay or Disability

Referring Individual

Reason for Referral

Family Information

This transmission is for the purpose of referral to the Saratoga County Early Intervention Program. By submitting this referral, it is understood that the information contained may be confidential or privileged and that all information will be handled and protected by Saratoga County per the requirements of all associated federal and state privacy laws.

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