Get Nbrc Intake Inquiry Packet 2018-2025

This guide provides a clear and supportive overview for filling out the NBRC Intake Inquiry Packet online. Designed for individuals seeking services for developmental disabilities, this packet is an essential first step in the intake process.

Follow the steps to complete the Intake Inquiry Packet with ease.

1. Click ‘Get Form’ button to access the inquiry packet and open it for further editing.
2. Begin by filling out the information for the individual being referred. Include first name, last name, age, date of birth, and preferred language. Ensure all fields are completed to the best of your ability.
3. Provide the mailing and home address of the individual. Include city, state, and zip code.
4. Enter contact information, including the individual's phone number and email address. Be sure to include a contact person’s name and their phone number as well.
5. Indicate who completed the form and their relationship to the individual being referred. Include information about the referral source.
6. Answer the relevant questions regarding prior services received from any Regional Center and if the applicant receives SSI benefits, including the date benefits began.
7. Detail any educational history, including the name of the current school, grade, and whether an IEP is in place or was present in previous schooling.
8. List the current health insurance provider and any current medical professionals involved in the applicant's care.
9. Document any current medications, diagnoses, and all past diagnoses if applicable.
10. Address specific concerns related to the applicant's development across various categories, such as intellectual disability, autism, cerebral palsy, or epilepsy. Provide careful and detailed descriptions in each section.
11. Complete the sections concerning records and reports that can aid in the evaluation process, as outlined in the inquiry packet.
12. Once all information is accurately filled out, review the completed NBRC Intake Inquiry Packet for any errors or omissions.
13. Save your changes, and download, print, or share the form based on your preference and requirements for submission.

Complete the NBRC Intake Inquiry Packet online today to begin the process of accessing vital services.