Early Support for Infants and Toddlers (ESIT)

Ages Birth to Three

To schedule a developmental evaluation to determine if your child is eligible for Early Support services (ages birth to three) call us at 253-854-5660 or fill out the online referral form below. A family Resources Coordinator will return your inquiry to gather information about your child and schedule an evaluation with our team.

If you have a concern about your child's development, don't wait to call us: evaluation is free!

All children should be able to access quality services. Early Supports for Infants and Toddlers (ESIT) is partly subsidized through government funding. We also bill private insurance and Medicaid. Through our contact with private insurance, we are required to collect co-pays, deductibles, and co-insurance associated with your child's insurance plan. It is the client's responsibility to understand their insurance benefits and their responsibility to Children’s Therapy Center. If you need help covering the cost of care, please speak with your child’s ESIT team.

Learn more about Family Cost Participation.

Please review our notice of patient privacy practices (HIPAA). You can also read more about our privacy practices here.

Have questions about Early Supports for Infants and Toddlers (ESIT) services? Learn more here or call us at 253-854-5660.

Get directions to our locations.

Early Support Referral (for children ages birth to 3)

Child's Information

Child's Name(Required)

First Last

Date of Birth(Required)

Gender(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Street Address Address Line 2 City State ZIP Code

Enter only if different from home address

Family Main Contact Information

Name of Parent/Guardian(Required)

First Last

Relationship(Required)

Best Daytime Phone Number(Required)

Interpreter Needed?(Required)

Yes

Email(Required)

Name of Person Completing Form

Same as above?(Required)

Yes

If you selected yes, you do not need to fill out the fields below.

Name of Person Submitting Referral(Required)

First Last

Relationship(Required)

If Other please indicate

Organization

Phone(Required)

Email(Required)

Reason for Referral (What are your concerns?)(Required)

Early Support for Infants and Toddlers (ESIT)

Ages Birth to Three

Early Support Referral (for children ages birth to 3)

Child's Information

Family Main Contact Information

Name of Person Completing Form

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