Intake Packets

The following are new intake forms used by the Cortland County Mental Health Department revised March 25, 2021: 

-The Adult Intake Form is for those age 18 and over. The Attendance Policy should also accompany the Adult Intake Form.

-The Children's Intake Form is for anyone 17 and under. Please include the Attendance Policy.  
 
These are fillable forms which can be emailed directly to CCMHD@cortland-co.org or print out and drop it off in person between 8 a.m. and 5 p.m. Monday and Friday, and 8 a.m. to 7 p.m. Tuesday-Thursday at:

Cortland County Mental Health Clinic
7 Clayton Avenue
Cortland, NY 13045

Please email Intake Forms to:  CCMHD@cortland-co.org

  1. Attendance Policy
  2. Intake Sheet- Adult
  3. Intake Sheet- Adult
  4. Intake Sheet- Adult
  5. Intake Sheet- Child
  6. Intake Sheet- Child
Mental Health Terms