New Client Intake

If you are a new client OR seeking an evaluation for speech, language, hearing, feeding, or cognitive concerns, please complete the appropriate intake packet (adult or pediatric) located below and return these forms to the Clinic. Evaluations are provided in-person at the Mysak Clinic and via teletherapy.

Once your evaluation packet is received, it will be reviewed by our clinical staff and you will be contacted if an evaluation can be scheduled. Ongoing therapy services are not guaranteed following an evaluation.

You may mail the forms to:

Teachers College, Columbia University

Attn: Mysak Clinic, Box 191

525 W 120th Street

New York, NY 10027

or Email the forms to: mysakcenter@tc.columbia.edu

Please note that the Mysak Clinic does not accept insurance, Medicaid or Medicare. Clients who receive therapy at the Mysak Clinic are responsible for payment. We charge a reasonable fee for registration in the programs offered. The Mysak Clinic offers a sliding fee scale for those individuals who cannot afford the full cost.

Before beginning services at the Edward D. Mysak Clinic for Communication Disorders, all clients are asked to complete the clinic intake and consent packet. This packet includes important information about clinic policies, privacy practices, consent for services, and billing procedures. It also collects basic contact and billing information needed to begin care.

Please review and complete the forms prior to your first appointment whenever possible. Your assigned graduate clinician will review the documents with you during your first session and answer any questions you may have.

Completed forms help us ensure that services can begin smoothly and that you understand the policies and procedures of the clinic.

Please download and complete the clinic welcome packet  along with the intake prior to your first appointment.