Form Directory

For applications requiring your response, please submit via your preferred method:

Download the form and return it via -

  • Traditional mail to: Hamaspik Theragen ATTN: Enrollment 1 Hamaspik Way Monroe, NY 10950
  • Email: intake@hamaspiktheragen.org
  • Fax: 8456555601

Intake Checklist

Includes complete list of required intake documents; please submit with your application

Member Application

Please complete and submit to obtain ongoing I/DD services

Intake Packet with Individual Authorization and Responsibilities

Includes required authorization form and other important individual notices

Psychological Evaluation Intake Checklist

Includes complete list of required intake documents, specifically for psychological evaluations; please submit with your application

Psychological Evaluation Application

Please complete and submit to obtain a psychological evaluation

Hamaspik Theragen Brochure

Provides details about our therapeutic supports and services

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COVID-19 UPDATE

COVID-19 has been detected in multiple communities around New York State. Visitors may introduce COVID-19 infection into the facility. NYSHA and its member Hamaspik agencies are issuing the following policy regarding visitors to all facilities, Day Habilitation, and Respite sites, IRAs and etc. to protect and maintain the health and safety of our residents and staff during the ongoing novel coronavirus (COVID-19) outbreak.

To prevent the introduction of COVID-19 into IRAs, CRs, and Private Schools:

Effective immediately,

NYSHA and its member agencies

• Suspend all visitation except when medically or clinically necessary (i.e. visitor is essential to the care of the resident).

In addition:


• Any visitors meeting these exceptions must be screened for symptoms (cough, shortness of breath, or fever) or potential exposure to someone with COVID-19 and the duration and number of visits should be minimized.

• NYSHA and its member agencies provide other forms of communication to meet the needs of our residents by calling each program director where detail guidance will be provided.

• These policies are in effect until further notification.

We are certain that families, advocates, and the public will appreciate these precaution measures for the health and welfare of the individuals