Sandbox - UBMD Psychiatry

Sandbox

Providers

UBMD Psychiatry is committed to improving the mental health of our community. As leaders in the field, our psychiatrists and psychologists provide a comprehensive array of mental health services at multiple locations across the Western New York area.

UBMD Psychiatry doctors offer care at multiple office locations in Buffalo and across Western New York. We are affiliated with local hospital systems, including Kaleida Health, and Erie County Medical Center (ECMC). Our physicians also serve patients at Buffalo General Medical Center, ECMC and the Oishei Children’s Hospital.

New Patient Intake Information

If you are interested in becoming a patient at our practice, please call our office at (716) 835-1246 ext:119 to complete a brief intake with our intake coordinator. Durning this call, we will:

Confirm whether your insurance is accepted, and
Discuss the type of treatment you are seeking to help us match you with the most appropriate provider.

A referral from your primary care provider (PCP) or therapist is required before scheduling an appointment. The referral form can be faxed to our office at (716) 835-0396.

For patients under 18, a copy of the most recent progress note from their pediatrician and therapist (if applicable) is required along with the referral.

If you are seeking treatment for ADHD, previous ADHD testing may be required. If prior testing is not available, you may be asked to complete testing before beginning treatment, at the provider’s discretion.

University Psychiatric Practice, Inc.

New Patient Intake Form

Please fill out the form below and submit. A member of our team will reach out to you shortly. Thank you!

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Name(Required)

First Last

Date of Birth:(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

(XXX) XXX-XXX

Best time to contact you:(Required)

Morning

Afternoon

No Preference

Primary Care Physician/ Practice:(Required)

Insurance:(Required)

Were you referred to UPP?(Required)

Yes

Other

Reason for seeking psychiatric care?(Required)

Are you currently taking psychiatric medications?(Required)

Who is prescribing?(Required)

Do you have a therapist?(Required)

Therapist Name (If applicable):(Required)

Please, have your Primary Care Physician and Therapist fax over your referral information (last office note) to us at (716) 835-0396. Indicate below if there is any other information you would like us to know:(Required)

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