Information / Referral for Services

Make a referral.

For evaluations, screenings, or to get started in any of our programs. You can refer yourself, your child, a family member, or a client. It takes about 5 minutes.

General Referral Form

Your answers are private. This form is encrypted, and what you enter is never sent by email — it goes straight to a secure inbox that only authorized Options & Advocacy intake staff can sign in to. Fill in what you can; the intake coordinator will go over the rest with you.

The person being referred

The below information is for the person being referred.

Gender (required)
Referred to (required)

Choose every program that applies.

Insurance & benefits

Insurance type
Please check all that apply

Primary contact

Who should the intake coordinator reach? A cell number or an email is required.

Secondary contact optional

If the person being referred is 3 years old or under

optional · tap to open

Please complete all of these questions for children age 3 or under.

Has the child or a sibling been previously enrolled in Early Intervention?

Consent

By providing information, you are attesting that either (1) you are your own guardian making a self-referral, (2) you are the youth's parent/guardian or (3) you have consent from the youth's parent/guardian to share this information. In any case, please be aware that the client and/or youth's parent/guardian will be contacted by an agency representative to obtain consent and in order to provide assistance in identifying appropriate services. If you do not provide the parent/guardian's contact information or if a parent/guardian cannot be reached to provide consent, the agency representative will not be able to follow up.

Prefer to call?

815-477-4720
  • Helping Us Grow (HUG)Prenatal – age 3ext. 234
  • Child & Family Connections (CFC) #25Birth – age 3ext. 238
  • Autism Resource Center (ARC)Autism, or suspected autismext. 254
  • Neuro Inclusive Counseling (NIC)Neurodiverse individualsext. 403

Child over age 3?

You can receive a developmental screening through your local school district.

In crisis? Call or text 988 (Suicide & Crisis Lifeline), any time. This form is not monitored around the clock.