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 Forms
- Referral Form
- Neonatal Intensive Care Unit (NICU) Referral Form
- Intake Information Form
- Determination of Need for Educational Surrogate Appointment
- Early Intervention Record Access Log (doc) (pdf)
- Health Summary
- Eligibility Criteria
- Informed Clinical Opinion (doc) (fillable doc)
- Informed Clinical Opinion — Other Medical Condition (pdf ) (fillable doc )
- Meeting Notification
- First Steps Brochure Order Form
- HIPPA Privacy Notice
- Provider Service Request Form (fillable pdf) (fillable doc)
- Complete IFSP Form (pdf) (fillable doc)
- IFSP Planning Worksheet (pdf) (doc )
- IFSP Planning Instructions (pdf) ( doc )
- Service Provider Daily Progress Report (pdf) (doc)
- Service Provider Monthly Progress Report (pdf) (doc)
Information Release, Consents, and Notice Forms
- Release of Information Form (pdf ) (doc )
- Release of Information Instructions
Notice of Action and Notice of Action/Consent Forms
Instructions (English)
The Notice of Action/Consent forms are available in eight languages below.