Make A Referral

A child can be referred to Child and Family Connections of Central Illinois Offices through parents, family members, physicians, regional diagnostic centers, hospitals, health departments, local screenings, or by anyone who is concerned about a child’s development. Evaluations to determine eligibility are provided at no cost to the family.

Make a referral by contacting the CFC that serves the county in which the child resides. A CFC representative will work with you to collect necessary contact information as well as the basic demographic information on the child. We will discuss any developmental concerns you may have, and are happy to answer any questions you have regarding the Early Intervention program. We look forward to helping each child reach their developmental goals.

CFC #14

Referrals are accepted for children birth to three living in Henry, Peoria, Stark, Tazewell, and Woodford counties. Start the referral process by using the link below or calling the CFC 14 office at 309‑672‑6360 opt # 1 or toll free at 888‑482‑4300.

Make a Referral to CFC 14

Child and Family Connections of Central Illinois Office 14
1014 W. Pioneer Pkwy Ste 110
Peoria, IL 61615
Toll free: 888-482-4300
Local: 309-672-6360
Fax: 309-681-0190

CFC #16

Referrals are accepted for children birth to three living in Champaign, Ford, Iroquois, Livingston, McLean, and Vermilion counties. Start the referral process by contacting the office staff at cfc16referrals@cicfc.org or by calling toll free at 800‑877‑1152 and speak to Office Coordinator, Katie Flynn, or Administrative Assistant, Cathy Thompson.

Make a Referral to CFC 16

Child and Family Connections of Central Illinois Office 16
201 West Springfield Ave Ste 508
Champaign, Illinois 61820
Toll free: 800-877-1152
Local: 217-693-7958
Fax: 217-693-7967

Referral Submission

"*" indicates required fields

Child's Information

Child's Name*

First Middle Last

Date of Birth*

Race

Gender*

Physician

Physician Phone

Physician Fax

Hidden

Physician

Household Information

How many are in the home?

Language(s) spoken in the home?*

Is an interpreter needed?*

Please select

Private Insurance Name:

Mother/Guardian*

First Last

Father/Guardian

First Last

Address*

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

Home Phone*

Alternate Phone

Work Phone (MOM)

Cell Phone (MOM)

Work Phone (DAD)

Cell Phone (DAD)

Referral Source Information

Which CFC Office?*

Are the parents aware of the referral?*

Family should be aware of you making referral to Early Intervention

Reason for referring / Diagnosis:*

Referral Name & Relationship to child*

First Last Relationship

Referral Email:*

This email will receive a copy of the submission for records.

Referral Address*

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

Phone*

If parent is referral source, how did they hear about us?

Apors Letter

Medical Person / Facility

Word of Mouth

Day Care / Teacher

Brochure

Additional Information

Is child in daycare?

Where?

Is child currently in the hospital?

When will child go home?

Foster Child?*

Case Worker Name:

Case Worker Agency:

Case Worker Address:

Case Worker Phone

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Comments

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