Get a Referral for PINES Services?

Children from birth to 3 years old who have a diagnosis of hearing or vision loss qualify for the PINES program.  Child must reside in Georgia.

• If your child has a diagnosis of hearing loss, we will need a copy of his/her audiology report.
• If your child has a diagnosis of vision impairment, we will need a copy of his/her vision report.  You may ask your child's eye doctor to complete our  eye report  form, or they can provide their own.  If your child has cortical/cerebral vision impairment (CVI), a report from their neurologist showing that diagnosis is also acceptable. 
• A  Completed referral form   - You may download and fill out this linked form, or you may fill out the online version of the form using the link below (click the ONLINE button to find the form).
• Basic information about the child and family, including contact information and any additional special needs the child may have.

• By phone

  • Call the intake line at 404-300-5905.
  • Georgia PINES' Admission Coordinator will ask for information about the child, family, and diagnosis of sensory loss.
• Online

  • Visit the online referral form.
  • Complete the referral form with all relevant information about the child, family, and diagnosis of sensory loss.
  • Georgia PINES' Admission Coordinator will contact you to complete the referral/intake process.  She will ask for information about your child, family, and diagnosis of sensory loss.
• By fax

  • Print the referral form and fill in all relevant information about the child, family, and diagnosis of sensory loss.
  • Fax the completed referral form, along with the audiological report and/or eye report, to 404-298-3610.
  • Georgia PINES' Admission Coordinator will contact you to complete the referral/intake process.  She will ask for information about your child, family, and diagnosis of sensory loss.

• For Children with Hearing Loss:  When the Admissions Coordinator has received all the required information and the necessary medical documentation, your family will offered a visit from an Early Hearing Orientation Specialist (EHOS).
• During this initial visit the EHOS will provide your family with information about the impact of hearing loss and specifics about your child’s hearing loss. The EHOS will give your family a list of service options, including PINES services from an Early Intervention Specialist (EIS), and help with referrals to services you would like to pursue ongoing intervention.
• For Children with Vision Loss:  When the Admissions Coordinator has received all the required information and the necessary medical documentation, your family will be assigned an Early Intervention Specialist (EIS).  Your new EIS will contact you to schedule your first visit.

• Once the Early Intervention Specialist has been assigned, he or she will make contact to schedule your first home visit. Our goal is for the first home visit to take place within 21 days from the date that the EIS is assigned to serve your family.
• Weekly visits from your EIS may take place in your home or virtually, depending on the preferences of the family and service provider. Learn what to expect from these visits by viewing the Georgia PINES home visit video.