Provider Enrollment Forms
All forms needed for the following First Steps provider types are provided below:
- Interpreters
- Occupational Therapist
- Orientation & Mobility Specialist
- Paraprofessional
- Parent Advisor
- Parent Mentor
- Physical Therapist
- Translator
- Service/Intake Coordinator
- Special Instructor/Developmental Therapist
- Speech Pathologist
- Transportation
- Vision Specialist
All other disciplines (listed below) still need to contact the Central Finance Office at 1-866-711-2573, Ext. 2, for Medicaid forms not provided below.
- Audiologist
- Counselor
- Dietitian
- Nurse (RN and LNP)
- Assistive Technology Provider (DME)
- Optometrist
- Physician
- Psychologist
- Social Worker
All Providers |
Agencies, or Providers Receiving Direct Payment to Payee Forms |
Provider Checklist (pdf) |
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W-9 (pdf) |
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CFO Service Provider/Payee Agreement (pdf) (Birth to 3 years) |
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Providers Offering Transportation Services |
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Electronic Signature (pdf) |
Transportation Checklist (pdf) |