Your child has been referred to the BLaST Early Intervention Program for an evaluation to determine eligibility and need for Early Intervention Services.
Below you will find Intake Questionnaires for ages 3 – 5. Please select the appropriate Intake form and complete it.
Once we receive your forms, our scheduler will be contacting you to set up an appointment for your child’s evaluation. If you have any questions, please contact Nikki Palmer at 1-800-326-8528. We look forward to seeing you and your child.