Do you have a concern about your child’s development, behavior, or learning? The first step in addressing your concern is to complete the intake packet below that coincides with your child's age.
If you have any difficulty in following the instructions listed on this page, please call our intake staff at: 617-636-7242. If appropriate, we can arrange for an intake visit with you, which will help you to complete forms, collect additional documentation, and select the best evaluations to meet the needs of your child.
Intake Packet
Is your child under the age of 5 years? Please send in the following:
- Parent intake form (to be completed by parent)
- Two-way release (to be completed by parent)
- Physician referral form (to be completed by child’s pediatrician)
- Observer Report (to be completed by Early Intervention, a teacher or other professional working with your child)
- Early Intervention Info/IFSP (if applicable)
- School Questionnaire (if applicable)
Is your child 5 years or older? Please send in the following:
- Parent intake form (to be completed by parent)
- Two-way release (to be completed by parent)
- Physician referral form (to be completed by child’s pediatrician)
- School Questionnaire (to be completed by child’s teacher)
- Observers Report (to be completed by other professionals if applicable)
- Copy of child’s current IEP and School Evaluation Reports (if applicable)
How do I submit paperwork once completed?
All forms can be downloaded and completed electronically. Once completed, please save a copy of these documents and send them directly to: CCSNForms@tuftsmedicalcenter.org
*DO NOT SEND PHOTOS OF PAPERWORK THEY WILL NOT BE ACCEPTED.
You will be notified when your information is received and reviewed. If we are in need of further information, a member of our intake team will notify you.
While we encourage all forms to be filled electronically and emailed, you can also print and mail these forms. Please send them to: 800 Washington St #334 Boston, MA 02111.
What can you do while you are waiting?
Due to our extended waitlist we suggest speaking with your child’s primary care doctor further about your concerns. Please check out our “Helpful Resources” tab for information for resources that may be helpful to your family.