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Kids Who Count provides a full developmental evaluation as the first step to find out if your child is eligible for early intervention services. Evaluations for Early Intervention eligibility are provided at no cost to the family. This takes place in your home with you, your child, and a team of early intervention professionals who will observe how your child plays, communicates and interacts with others.

What is a developmental evaluation?

The evaluation looks at the following areas of your child’s development:

  • Cognitive: Learning, thinking, playing and problem-solving
  • Communication: Understanding what others are saying; expressing thoughts through gestures, sounds and words
  • Social/Emotional: Getting along with others, self-soothing and participating in routines
  • Physical: Coordinating movements; manipulating toys, sitting, crawling and walking
  • Self-Help/Adaptive: Calming, feeding, sleeping and dressing
  • Health, Hearing and Vision.

Please complete this form to refer a child. Our intake coordinator will call you to discuss your concerns and schedule an evaluation.

Child Info

MaleFemale

Mother/Guardian

Father/Guardian

Is this child in foster care? YesNo
What type of insurance is your child eligible for?*
Ethnicity
Race (choose all that apply)

Child's Primary Doctor's Info

What concerns you about your child’s development?* (choose all that apply)
Other Concerns

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