Intake forms & documents

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Individual Provider Services Agreement
File Size:	30 kb
File Type:	docx

Download File

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Consents/Releases
File Size:	45 kb
File Type:	docx

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FMS HIPAA
File Size:	39 kb
File Type:	docx

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HIPAA Privacy Summary
File Size:	381 kb
File Type:	pdf

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Intake Form- Adult
File Size:	407 kb
File Type:	pdf

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Intake Form- Adolescent
File Size:	600 kb
File Type:	pdf

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Intake Form- Child
File Size:	446 kb
File Type:	pdf

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Our location

6556 East Quaker
Orchard Park, NY 14127
phone: 716.539.9232
fax: 716.539.9230

Parking in rear of building