Refer a Child

Children grow and develop rapidly during their first three years of life. Although each child is special and grows and learns at his or her own pace, some children need extra help. This extra help is called Early Childhood Intervention or ECI. The earlier a delay is identified and a child receives intervention the better the outcome. For this reason, it is important not to wait.

Anyone can refer a child to ECI. Call our ECI Referral Line now at 915-534-4324 or submit an online referral below.

El Paso & Hudspeth County Residents:

To refer a child, fill out the form and click submit. You will receive an e-mail verifying we received your referral. The ECI program closest to you will contact you either by mail or phone. A response is necessary from the parent once receiving a letter or phone call to initiate services.

Please fill out required fields as indicated by an asterisk *

Date:*

Referral Source Information/Send Follow-up Information To:

Physician (if applicable):

Person Referring:*

Email:*

Agency (if not applicable, type "none"):*

Agency Address:

Address/P.O. Box City State Zip Code

Referral Source Phone:

Did you hear about us on Social Media/Google?

Yes

CHILD INFORMATION

Child MUST be under 3 years old and live in El Paso or Hudspeth county.

Child's Name:*

Sex:*

Type of Insurance:

Date of Birth (child must be under 3 years old):*

month

day

year

Child's Address:*

Address/P.O. Box City Zip Code

Phone Number:*

Alternative Phone:

Email :

Hispanic or Latino?*

Race:*

Primary Language:*

Mother's Name or Guardian:*

Father's Name or Guardian:

Pediatrician:

Reason for Referral:*

Comments:

Upload File(s):

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