Registration


Welcome to UP Early Intervention Clinic Inc! We are so excited to have you join our community. Please complete the following registration form so that we can provide the very best care to your family.

*   denotes required fields

Referral Information
Family Information
Where do you live?
Additional Info
Contact #1
How Can We Contact You?
Portal Access (your email is your login)
(Emails are kept confidential)
Contact #2
How can we contact you?
(Emails are kept confidential)
Student #1
(format=mm/dd/yyyy)
Additional Info

Please click on the Search button below, then choose the class.

Enroll in Classes
Select Class
Required Policies
 (Show-Hide Details)
Questions or Concerns
Payment Information
Credit Card