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Refer a Patient: Early Intervention Services

1. Fill out the referral form

Download and complete our mental health and child development referral form. The child's parent or guardian must fill out the release of information / consent for referral portion of the form for us to process the referral.

2. Send it to us

Fax the completed referral form to (510) 985-2202

Need help?

Get help making referrals
Pediatric Access Center

(877) 822-4453 (877-UC-CHILD)

Fax Oakland: (510) 985-2202

Fax San Francisco: (415) 353-4485

Talk to a physician liaison
Physician Liaison Service

(800) 444-2559

(415) 353-4395