Stars Infant Program (844) 700-9889

For families · English

Start an Early Start request

One flyer and one table tent card. Print both from this page, or download the PDF.

Download the PDF

Before you print

What will print

Both pieces are shown at their printed proportions.

For families

Start an Early Start request

A developmental assessment for a child under age 3. A diagnosis is not required to begin.

QR code that opens the Early Start form

Scan to start

Cannot scan? Type this address:

hipaa.jotform.com/230376375233152

Or call (844) 700-9889

Early Start developmental assessments are provided at no cost to families.

Stars Infant Program · 6910 Santa Teresa Blvd., Suite 200, San Jose, CA 95119

For families

Start an Early Start request

QR code that opens the Early Start form

Scan to start

Cannot scan? Type this address:

hipaa.jotform.com/230376375233152

Or call (844) 700-9889