Referrals for diagnostic evaluations (e.g., for ADHD, learning disabilities, intellectual developmental disabilities, etc. ) must complete an Assessment Referral Form. The form can be completed electronically by clicking the button below.
Current clients please click on the links below to sign-in and access the release of information forms through the IntakeQ/PracticeQ client portal. If you are not a current client, please click the Contact Us! button below and request the release of information form you require.
If submitting forms to our practice from other organizations please include your specific provider's name on the form.
Use the form above to request our practice (Confluence Children and Family Psychology, PLLC) exchange information with medical professionals, therapists, agencies, schools, etc.
Use the form above to request our practice exchange information with NYS agencies such as the Office of Mental Health (OMH) or the Office of People with Developmental Disabilities (OPWDD).