Online Referral Form

✿ For Redwood Coast Regional Center ✿

Early Start Referral

For any referral for Early Start Services for children aged 0-3, please complete this referral form. These authorizations will be under PR1380. A password will be required to enter the referral portal.

Children Older than Three

For any referral for a child over the age of 3, please complete this referral form. These authorizations will be under PR1379. A password will be required to enter the referral portal.