Please use this form only if:
  • You have never been a patient in the Child Cognitive Behavior Therapy (CBT) Program, OR
  • You have been a patient in the Child Cognitive Behavior Therapy (CBT) Program but are seeking an appointment with a new clinical area or doctor

The Child Cognitive Behavior Therapy (CBT) Program delivers short-term, problem-focused, skills-based therapy to patients ages 3-24, with a variety of issues, including anxiety, depression, ADHD and other difficulties. Our intake process helps us understand your child and determine whether our program is best suited to meet your child's needs.

After you submit the form, a representative will call you back with the information you’ll need to make an appointment. You may also speak with a representative directly Monday–Friday, 8:30 am to 5:00 pm EST by calling 617-643-9898.

Due to the high volume of patients, we currently have a waiting list. You may need to wait up to several months for an initial evaluation.


If you are seeking care for your child that is more urgent and cannot wait a week to hear back from us, we are most likely not the appropriate referral for your child. If your child needs urgent psychiatric care, we would advise you to contact your nearest emergency room or to talk to your child's pediatrician about referral to a clinician who might be able to evaluate them sooner.

Important note: Some questions on this form may appear or disappear based on your responses.

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Please call 911 if you are experiencing a medical emergency.

Requestor Information

If you are an international patient, please complete the International Patient Appointment Form.

Patient Information


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