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OPWDD Intake Forms

Please download these forms, complete them and mail them to:

Attn: Laurie Gendron
1000 Elmwood Ave.
Suite 900
Rochester, NY 14620

Universal Forms (forms that must be completed in addition to any of the below programs)

Intake Application

Notice of Privacy Practices

Notice Acknowledgment

Photo Consent Release Form

Community Habilitation (formally In-Home Residential Habilitation)

Directions

Part 1

Part 2

In-Home Respite, Community Recreation Respite and Wrap Around Program Forms

Authorization Form

If there you have any questions regarding these forms or a specific program,
please contact Laurie Gendron at 585.295.1587 ext. 2281 or lgendron@cprochester.org