Referrals for diagnostic evaluations (e.g., for autism, AD/HD, learning disabilities) must complete a Prescreening Form. The completed form can be mailed or faxed (607-238-3749) to our office.

Please note that providers are working on evaluations regularly, but the waiting list is usually very long. Our office will contact you after the prescreening form is submitted to discuss if we can provide the requested services.

FCAC Prescreening Form - Child

FCAC Prescreening Form - Adult

Please contact the office to discuss provider availability.

Please select the authorization form for your provider. If you are not sure which provider you are seeing, please contact the office.

Forms from other agencies/providers will also be accepted, as long as the specific provider name is included.

NOTE: All providers are independent practitioners who are legally responsible for their own records.

Authorization Form - Dr. Duell

Authorization Form - Dr. Esteban-Elie

Authorization Form - Dr. James

Authorization Form - Dr. Scott-Richard