REI Custom Program Intake for Children Birth to 3

Please complete and submit the intake, We will place your first REI Custom Program track in your account within 24 hours.

Call us at 800-659-6644 or email us at with any questions.


Please select a rating for each of the following questions. Refer to behavior for the past 3 months. For each item, decide whether the behavior is relevant and to what degree.

  • Not relevant = You never see this behavior
  • Slightly relevant = You rarely see this behavior
  • Pretty relevant = You occasionally see this behavior
  • Very relevant = You often see this behavior

Remember: Don’t think too hard about the answer — your first reaction is usually the right one.

Name of Contact Person

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