If you are working with a family and would like to refer them to SEAS on their behalf, you can complete the referral forms below. Referral forms can be faxed to SEAS confidential/HIPAA compliant fax: 360-676-6729. Please do not email this form, as our email is not secure. If you do not have access to fax, you can call in the referral to SEAS: 360-715-7485. A navigator will collect family’s demographic information and information about the concerns and needs for the family.

Medical Provider: If you are a medical provider (such as a doctor, nurse practitioner, hospital, etc.) please complete the SEAS Medical Provider Referral form, as some services will require a signature and a diagnosis code. Make sure to include medical/chart notes and any relevant screenings such as an ASQ, MCHAT, or EPDS.

All Other Providers: If you are NOT a medical provider (such as a social/nonprofit worker, school, childcare, CPS, etc.) please complete the SEAS NON Medical Provider Referral form (please use the medical provider referral form above if you are doctor, nurse practitioner, or another type of medical provider). This form includes an additional page where you can provide more information about the concerns and needs for the child, parent, and/or family. It is incredibly helpful for SEAS to have this information.

If you are a parent and want to connect to SEAS, you can call the SEAS line: 360-715-7485 or submit a call request on the contact us page.