CHILD & ADOLESCENT INTAKE FORM
FOR PATIENTS 17 YEARS & YOUNGER IN THE BUFFALO, NY REGION

The clinical psychologists at WNY Psychotherapy Services have gone to great lengths to streamline the standard intake process. We understand that parents in the Buffalo, Hamburg, Orchard Park, and Tonawanda, NY communities have got a lot on their plates. Keeping this in mind, we've developed this simple form to help local families save time and reduce stress.

Submit the provided form and take the first step toward accessing proven child therapy services. Although you will be required to complete additional paperwork when you arrive for your child's initial appointment, this form will help you to gain a head start on the registration process. As always, you're more than welcome to contact one of our knowledgeable representatives with any additional questions, comments, or concerns.

IMPORTANT NOTE: This form below DOES NOT take the place of your "New Patient Packet Forms" that are filled in for your initial appointment. You can download them online by going to your assigned provider page once intake schedules your appointment to print and fill in the forms before your appointment. Otherwise, please arrive 30 minutes before your appointment to receive the required paperwork to be filled in before your initial visit. Thank you!