Early Intervention Referral for Berks County Children
Service Access and Management takes Early Intervention referrals for children through an online form at wellness.sam-inc.org/ei_referral. Berks is one of the counties you can choose for the child's residence, along with Clearfield, Franklin, Fulton, Huntington, Jefferson, Juniata, Lebanon, Luzerne, Mifflin, Potter, Schuylkill, Tioga and Wyoming.
A referral can be sent by a parent or family member or by someone else involved with the child. The form's list of referral sources includes childcare, Children & Youth Services, a home visiting or family center, a homeless shelter, a hospital or NICU, other early childhood programs, another social services agency, other medical sources, a parent or family member, and a physician or healthcare provider.
The form asks for: - the referral date and the county where the child lives - the name and phone number of the person making the referral, and their relationship to the child - the child's name and date of birth, and the child's address with city, state and zip - the parent or guardian's name and primary phone - the reason or concern behind the referral
There are also optional spaces for the primary language, the referral email address and fax number, the child's Social Security number, the parent or guardian's email and secondary phone, insurance information and comments.
You can attach up to five files in PDF, JPG, PNG or TIFF format, up to 10 MB each. Executable files such as EXE, PHP and scripts are blocked. After you press submit, the form shows a processing message.
The form itself does not say who qualifies, what services a child may receive, what happens after a referral is sent, how long it takes or whether there is any cost. No phone number or office address is listed on the form for asking those questions.
Source: berkspa.gov/departments/mental-health-developmental-disab…, read October 25, 2026.
The details
In Berks County Mental Health / Developmental Disabilities Program’s words
Early Intervention Referral EARLY INTERVENTION REFERRAL FORM Referral Date (required) County of Child's Residence (required) select county... PA - Berks PA - Clearfield PA - Franklin PA - Fulton PA - Huntington PA - Jefferson PA - Juniata PA - Lebanon PA - Luzerne PA - Mifflin PA - Potter PA - Schuylkill PA - Tioga PA - Wyoming Referral Source Name (required) Primary Language Referral Phone Number (required) Referral Relationship to Child select one... Childcare Children & Youth Services Home…
Organization
Berks County Mental Health / Developmental Disabilities Program
Organization profile in our directory →About this listing
This listing summarizes publicly available information from berkspa.gov/departments/mental-health-developmental-disab…. Last recorded review: October 25, 2026. Contact the provider to confirm eligibility, hours and availability before you go. If something here is wrong, tell us.