Please note that this is a referral form to be completed ONLY by the individual over the age of 18 seeking supports, the parent of an individual under the age of 18 who is seeking supports, or the legal guardian of an individual seeking supports.
For individuals ages 3 and above, please contact the Hamilton County Developmental Disabilities Services Introduction and Eligibility team at (513) 559-6990 (Monday through Friday 8am to 4pm) for a prescreening or complete the secure web based online prescreening form below.
For individuals ages 6 and above, before completing the form please note that the person seeking supports must confirm that:
- the disability is attributable to physical or mental impairments other than a sole diagnosis of mental illness;
- the person’s disability(s) was manifested before the age of 22;
- the person’s disability is likely to continue indefinitely.
If the answer is yes to all 3 questions above, please complete the form and a representative from Introduction and Eligibility will review it and contact the individual, family or legal guardian as applicable for additional information.
*indicates a required field.