Applying for Services

Children Ages 0-3

If you are concerned about a child’s development or are interested in Perry County Early Intervention, or you know of a family who could benefit from the Help Me Grow Home Visiting program, the first contact for families of children aged 0-3 is Help Me Grow central intake. To make a referral, call (740-371-3322) or use the online form.

Once basic information is received, it will be determined if an evaluation and assessment is needed to identify if the child has a disability or delay and what services may be needed. If evaluation and assessment are warranted, the Perry County Early Intervention Service Coordinator will schedule this with the family.

Ages 3 and Above

For individuals ages 3 and above, a referral for services provided by the Perry County Board of Developmental Disabilities can be made by providing the information in the contact form below.

Once basic information is received, an Intake representative will review the documentation and contact the individual or family for additional information and/or to schedule a face to face meeting.

To make an online referral for ages 3 and above, please complete the area below.

Referral for Services –

Ages 0-3 use online form – click here

Ages 3 and above – use form below

Name of Person being Referred
Parent Name, if available
Date of Birth of Person being Referred, if Available
Mailing Address of Person being Referred
Street Address Address Line 2 City State ZIP Code
Contact Information of Person being Referred (Phone/Email)
Person/Agency making Referral
Reason for Referral
Contact Information of Person making Referral (Phone/Email)
Name
This field is for validation purposes and should be left unchanged.

For more information about Intake and Eligibility

Please contact
Vikki Waymire
Eligibility Specialist
740-684-2210
v.waymire@perrydd.org

If you prefer to email or print the referral form

Please click on the link below
Referral Form PDF