First Steps Forms
Below are pertinent First Steps program forms grouped together by category.
General Forms
- First Steps General Information Brochure English Spanish
- Parental Rights Statement
Quick Category Access
Referral, Intake, and Eligibility Determination
- Referral Form
- Neonatal Intensive Care Unit (NICU) Referral Form
- Intake Information Form
- Early Intervention Record Access Log (doc) (pdf)
- Health Summary
- Eligibility Criteria NEW!
- Informed Clinical Opinion (doc) (fillable doc)
- Informed Clinical Opinion — Other Medical Condition (pdf ) (fillable doc )
- First Steps Brochure Order Form
- HIPPA Privacy Notice
- Provider Service Request Form (fillable pdf) (fillable doc)
- Complete IFSP Form (pdf) (doc) NEW! Fill forms COMING SOON!
- IFSP Planning Worksheet (pdf) (doc )
- IFSP Planning Instructions (pdf) ( doc )
- Service Provider Daily Progress Report (pdf) (doc)
- Service Provider Monthly Progress Report (pdf) (doc)
- IFSP Meeting Notification NEW! (pdf ) (doc )
Release, Consent, and Notice NEW!!
Release of Information
- Release of Information Instructions - English
- Release of Information Form - English (pdf ) (doc )
Notice of Action/Consent
- When to Use Notice of Action and Notice of Action/Consent
- Step by Step Instructions for Notice of Action/Consent - English
- Notice of Action/Consent - English (pdf ) (doc )
Notice of Action
- Step by Step Instructions for Notice of Action - English
- Notice of Action - English (pdf ) (doc)
Click HERE for forms in additional languages