Get E.r.i.k. 36 Months

Filling out the E.R.I.K. 36 Months form is a crucial step in ensuring that your child receives the necessary evaluations and services. This guide will provide you with comprehensive, step-by-step instructions to make the process straightforward and user-friendly.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in the date and the child's name in the designated fields.
3. In the next section, provide the child's date of birth and the parent(s) or guardian's name.
4. Enter contact information including home, work, and cell phone numbers, as well as an email address.
5. Provide the child’s full address along with the postal code.
6. If your child has any flags, indicate 'Yes' or 'No' and if 'Yes', fax your referral to Central Intake.
7. Respond to the questions regarding the child’s understanding and social skills by selecting 'Yes' or 'No' for each question.
8. Next, indicate if anyone has noticed any specific issues regarding skill loss or social interaction by filling out the appropriate 'Yes' or 'No' responses.
9. Specify the referral source's details, including name, phone, fax, address, and email.
10. Sign and date the parent guardian consent section, confirming your consent for the referral.
11. Make any necessary notes in the provided section at the end of the form.
12. Once all sections are completed, save your changes, then download, print, or share the form as needed.

Complete the E.R.I.K. 36 Months form online today to ensure your child receives the support they need.