Referral Forms

Make an online referral for any of our services by completing one of the forms below.

Note: This information is transmitted and stored using secure encryption technology. 

Referrals for Parent Infant Program (PIP) Services – Birth to Age 3

See our document: Outline of PIP Referral Process

Note to Diagnosing Audiologists for PIP Referrals:

• Send referral directly to CIS-EI (Children’s Integrated Services-Early Intervention).
• Simultaneously, send referral and report to Nine East Network for tracking purposes.
• In diagnostic report, please document discussion with family of referral to PIP.

Referrals for Pre-K and School-Based Services – Age 3 and Older

Due to the fact that Nine East Network is no longer administering the VT Deaf and Hard of Hearing Program, we are no longer accepting referrals for TOD Consulting services.  Birth to 3 and ASL referrals will be accepted until August 13, 2021.