SMART Online Referral Form

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This form is designed to collect referrals for the SMART (School Medical Autism Review) Team serving Pacific and Grays Harbor Counties. We gladly accept referrals for children up to the age of 10, residing in either Grays Harbor or Pacific County, from various sources familiar with the child, such as parents, caregivers, school districts, agencies, medical providers, and daycare providers.

To ensure confidentiality, this form does not gather information about the child being referred. Instead, we will contact you after receiving your referral to obtain the necessary details. A copy of your responses will be sent to the email address provided in the form.

Professionals: Please inform the family before submitting a referral.

If you have any questions, please reach out to Stefani Joesten at 360.500.4350. For additional information and resources, please visit our website HERE.

Email *

Your First Name *

Your Last Name *

Your Phone Number *

Please select the option that best describes your involvement with the child you are referring: *

Parent or guardian of the child

Teacher or school staff member

Healthcare professional

Social worker or counselor

Community member or concerned citizen

Daycare provider

Other:

The child I'm referring resides in: *

Grays Harbor

Pacific County

A copy of your responses will be emailed to the address you provided.

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