Form Downloads
New York City
Suffolk County
Nassau County
General
New Providers
New York City
- Assistive Technology Specification Form
- Interventionist Step-by-Step Reference Guide
- Community Health and Safety Survey-Indoor Areas
- DOE Early Intervention Guide EI-to-Pre-K Transition
- Justification for Change in Frequency, Intensity or Method of Services
- Notification of Non-Delivery of E.I. Services
- Provider Progress Note
- NYC EIP Session Note (One Session Notes Per Page)
- NYC EIP Session Note (Two Session Notes Per Page)
- Community Health and Safety Survey Outdoor Area
- Welcome Letter for Parents
- Welcome Letter for Parent (Spanish)
Suffolk County
- Prescription/Recommendation for Preschool Services
- Psychological Counseling Referral for Evaluation / Services
- Authorization for Alternative to Parent/Guardian/Caretaker Signature
- Prescription/Recommendation for Evaluations
- Medicaid Consent Form
- Notification of Extended Non-Delivery of Services Early Intervention
- Suffolk County Ethics Policy Provider and Family Agreement for Related Services
- Suffolk County Preschool Special Education Program Record of Related Services Log Notes
- Suffolk County Preschool Special Education Program Record of Services Log Note
- Suffolk County Early Intervention Progress Report
- Suffolk County Related Services Policy and Procedures Manual
- Verification of Absence and Make-up Session
- Parent/Guardian Consent For Alternate Verification Signature
- Annual Review Progress Report
- Notification of Extended Nondelivery of Services Preschool Related Services
- Special Education Preschool Program Related Service Quarterly Progress Report – Summer
- Suffolk County Early Intervention Program – Session Note
- Welcome Letter
Nassau County
- Applied Behavioral Analysis Team Leader Progress Report Family Training
- Applied Behavioral Analysis Team Leader 6-Month Progress Report
- ABA Team Member Progress Report
- Parent/Guardian Consent For Alternate Verification Signature
- Daily Notes/Attendance Sheet
- Notification of Non-Delivery of Authorized Services
- 6 Month Progress Report
- Medicaid Parental Consent
- Preschool Special Education Program Manual
- Physician Prescription for Evaluation (Preschool Special Education Program)
- Prescription For Preschool-Based Related Services
- Treatment Log – Related Services
- Treatment Log Guidance Document
- Parent/Guardian Consent For Alternate Verification Signature
- Physician Prescription for Evaluations
- Nassau DOH EI Session Make-Up Policy
- Welcome Letter for Parent – Nassau and Suffolk
General
- CPSE Annual Review Meeting Results
- Annual Review Cover Sheet
- Preschool Related Service Billing Manual
- Parent/Guardian Consent for Evaluation
- Policy & Procedures Manual for CPSE: Evaluations and Related Services
- Quarterly IEP Progress Marks and Annual Review Progress Reports Guidelines
- Preschool Quarterly Progress Reports: Attestation Form
- Fraud Prevention
- DRA Notice 2023
- NOTICE Re: The Number of Sessions Taken On
- NOTICE Regarding Late Billing
New Providers
- Background Screening Authorization
- W9
- Medicaid Compliance
- Reference Check
- Statewide Central Register Databse Check
- Therapist Information
- Vaccination Consent/Waiver
- Frequently Asked Questions Regarding Annual Tuberculosis (TB) Testing for Early Intervention Providers 5-10-2022
- Physical Examination Form for Therapists
