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 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:

*Please note that effective 8/14/2023-10/13/2023 we will only be triaging intake referrals from the following community partners: Legal representatives, Department of Social Services, Hospital and residential providers, and crisis referrals.  

Mental Health Terms