Referring a Family to SEAS
If you are working with a family and would like to refer them to SEAS on their behalf, you can complete the referral forms below.
Referral forms can be faxed to SEAS confidential/HIPAA compliant fax: 360.676.6729.
Please do not email the form, as our email is not secure.
If you do not have access to fax, you can call in the referral to the SEAS line: 360.715.7485. A navigator will collect family’s demographic information and information about the concerns and needs for the family.
Medical Providers
If you are a medical provider (such as a doctor, nurse practitioner, hospital, etc.) please complete the SEAS Medical Provider Referral Form as some services will require a signature and a diagnosis code.
Make sure to include medical/chart notes and any relevant screenings such as an ASQ, MCHAT, or EPDS.
Non Medical Providers
All Other Providers: If you are NOT a medical provider (such as a social/nonprofit worker, school, childcare, CPS, etc.) please complete the SEAS NON Medical Provider Referral form.
This form includes an additional page where you can provide more information about the concerns and needs for the child, parent, and/or family. It is incredibly helpful for SEAS to have this information.