Blank Forms
The forms below are standalone files that are NOT connected to the BTOTS database. They are NOT designed for use within
a web browser. Before you attempt to enter data or print these forms: 1) Download the form to your computer, and 2)
Open the form in a PDF application such as Adobe Acrobat Reader. You can create pre-populated forms from within each
child's record > Summary tab > Printed Forms.
BTOTS Blank Forms |
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| Tele-intervention Consent
3/28/2023 |
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| Authorization to Release Information FILLABLE PDF | ENGLISH | SPANISH 08/30/2023 |
| CHARM Consent FILLABLE PDF | ENGLISH | SPANISH 2020 |
| Evaluation and Assessment Consent FILLABLE PDF | ENGLISH | SPANISH 03/26/2025 |
| Contact Log | ENGLISH | SPANISH 05/01/2013 |
| Contact Log "Reason for Contact" Definitions
4/18/2014 |
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| IFSP Complete | ENGLISH | SPANISH 09/22/2015 |
| IFSP Periodic Review
01/10/2020 |
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| IFSP Amendment
09/22/2015 |
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| Prior Notice | ENGLISH 2024 | SPANISH 2024 |
| Service Visit | ENGLISH | SPANISH 05/01/2013 |
| Transition | ENGLISH | SPANISH 10/10/2014 |
| Authorization to Release and Exchange Records between EI and the Local School District | ENGLISH | SPANISH 11/26/2014 |
| Consent to Decline the Referral Notification to the SEA/LEA | ENGLISH | SPANISH 10/10/2014 |
| Written Notice of Eligibility | ENGLISH | SPANISH 03/28/2025 |
| Written Notice of Ineligibility | ENGLISH | SPANISH 03/28/2025 |
General Forms |
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| Initial Health, Hearing, and Vision Assessment
06/22/2023 |
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| Annual Health, Hearing, and Vision Assessment
06/22/2023 |
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| Initial Health, Hearing, and Vision Assessment FILLABLE PDF | ENGLISH | 2021 |
| Annual Health, Hearing, and Vision Assessment FILLABLE PDF | ENGLISH | 2021 |
| Approved Diagnosis List
03/28/2025 |
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| Parent Rights and Responsibilities Brochure | ENGLISH | SPANISH 2024 |
| Welcome to Baby Watch Brochure | ENGLISH | SPANISH 2025 |
| Social-Emotional Development Brochure | ENGLISH | SPANISH |
Family Fee |
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| Family Fee Determination Form | ENGLISH | SPANISH 10/17/2017 |
| Sliding Fee Scale 7/1/2024 | ||