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  • Child Find Request A Screening

    FDLRS Crown Serving Clay, Duval and Nassau Counties

  • Currently wait time to receive a call back is longer than 4 weeks. 

    We apologize for the delay and will process your referral as quickly as possible. Please note our office is open Monday through Friday from 8:00 am until 4:00 pm to receive referrals.

  • Request A Screening 
    for Clay, Duval and Nassau Counties 

    Please complete the following form for your child age 3 to 5 to request a screening. Once this form is completed you will be contacted to set up an appointment in approxamatly 3 to 4 weeks. 

  • To request a screening for all other counties click here.

  • Child's Information

  • DATE OF BIRTH*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Gender*

  • Parent / Guardian Information

  • The Child Lives With*
  • Format: (000) 000-0000.
  • Can we text to this number?
  • Format: (000) 000-0000.
  • Can we text to this number
  • Format: (000) 000-0000.
  • Can we text to this number
  • Do you have a court order or guardianship or is there a Termination of Parental Rights?
  • Are you or your spouse a member of the military?
  • Are there other languages spoken in the home besides English?*
  • Will the parent need an interpreter during the screening?
  • Will the child need and interpreter during the screening?
  • Does your child have agency caseworker?
  • Format: (000) 000-0000.

  • Reason for Requesting the Screening

    Please provide all the relevant information so we can best help your child.
  • Reason for requesting a Screening. (Mark all that apply)*
  • Does your child have an Individual Education Plan (IEP) from Florida or any other state?*
  • Have any educational evaluations been completed by another agency or doctors office? (This may include psychological or neuropsychological evaluations)
  • Does your child have a medical diagnosis?
  • Does your child receive any of the following services from a private provider and or agency?
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