Make a Referral or Request Assistance

Help  the Florida & Virgin Islands (FAVI) Deaf-Blind Collaborative to help children and youth with deaf-blindness and their families!

We encourage families to report a child/young adult (birth through age 21), request consent, and provide consent for exchange of information and records using the online Family Intake survey: https://ufl.qualtrics.com/jfe/form/SV_6fWdAe0jHvo8oxE

Educators and professionals may also make referrals using the Family Intake survey,
but consent must be provided by a parent/guardian for exchange of information and records.

Any family member or professional may report a child or young adult ( ages birth through 21) to the Florida deaf-blind registry by contacting FAVI at 1-352-273-7529.

PLEASE SUBMIT ALL FORMS WITH ANY IDENTIFYING INFORMATION (names, addresses, birth dates, etc.)

  • BY FAX 352-273-8539
  • OR Contact Shelly Voelker (shellyv@ufl.edu) for mailing instructions.
  • Email is not a HIPAA-compliant means of exchanging protected information.

Referral Forms and Information