Florida Diagnostic and Learning Resources System
(FDLRS/NEFEC)

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Child Referral Form
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Child Referral Form

If you think that your child may need a developmental screening to identify a potential delay, please complete this form to send the info to one of our Child Find Specialists. They will contact you to schedule a screening.

 

Select your county : *Is your county not listed? Find the FDLRS Center that serves you.

Select your child's age :

Your name

Your address

Your city, state, zip

Your phone # and / or your email address