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RESET FORM Submit completed packet to: One of Provider Services Email: bhrecreden aling@cchealth.org or Fax: (925) 6086794Contra Costa County Behavioral HealthLEGAL NAME CHANGE From This form is used
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Obtain the help-me-grow-provider-referral-form from the appropriate organization or agency.
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Fill out all the required fields on the form, including the child's information, parent/guardian information, and reason for referral.
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Review the form for accuracy and completeness before submitting it to the designated contact or organization.

Who needs help-me-grow-provider-referral-form?

01
Parents or guardians seeking assistance for their child's developmental needs.
02
Healthcare providers or educators referring a child for developmental screening or early intervention services.
03
Social service agencies working with families that may benefit from help-me-grow services.
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Help Me Grow Provider Referral Form is a document used to refer children to early intervention services.
Healthcare providers, educators, and caregivers may be required to file the Help Me Grow Provider Referral Form.
The form can be filled out online or in person, providing detailed information about the child's development and any concerns.
The purpose of the form is to identify children who may benefit from early intervention services and connect them with appropriate resources.
The form may require information about the child's developmental milestones, concerns, and contact information for the referring party.
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