Ways to Make a Referral
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At a minimum child's name, address, phone number, date of birth, parent's name and contact information,
and reason for referral will be needed at the time of referral. If an Ages and Stages Questionnaire (ASQ)
was done, it is helpful to include the information and results page in your referral. When making a
referral for Communication, it is also beneficial to know if the child has had any ear infections.