WNY Psychotherapy Services

 

 

ADULT INTAKE FORM - WNY Psychotherapy Services Adult Intake Form - 18 Years and Up

IMPORTANT NOTE:  This form below DOES NOT take the place of your "New Patient Packet Forms" that are filled in for your initial appointment.  You can download online by going to your assigned provider page once intake schedules your appointment to print and fill in the forms before your appointment or please arrive 30 minutes before your appointment to receive the required paperwork to be filled in before your initial visit.  Thank you!  

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Please fill in at least one phone number above where we can reach you.

Linda Aidala, Ph.D. Gary L. Bernstein, Ph.D. Donna Bingham, LCSW
Anthony Bongiovanni, Ph.D. Sally Briggs, Ph.D. Barbara Christman, LCSW
Annie Coburn-Kane, LCSW Erin Cornelius, Ph.D. Matthew Davis, LCSW
Angelina Delgosha, LCSW Scott A. Gee, LCSW-R Mary Jo Gervase, LCSW
Mackenzie Halker-Davis, LCSW Julie Kramer, LCSW Marlene Longdon, PMHNP-BC
Robert Minkoff, Ph.D. Vicki Murphy, PMHNP-BC Linda B. Nash, Ph.D.
Bruce Pace, Ph.D. Tracey E. Pay, LSCW John Perak, LCSW
David Pratt, Ph.D. Sarah Rowland, Ph.D. Jennifer Sands, Psy.D.
Russell Shefrin, Ph.D. Nancy Skelton, LCSW Wendell Wild, LCSW
Joseph Zannoni, LCSW
Monday AM Monday PM
Tuesday AM Tuesday PM
Wednesday AM Wednesday PM
Thursday AM Thursday PM
Friday AM Friday PM
Saturday AM
Abuse/Domestic Violence Issues Behavioral Problems
Communication Problems Depression
Grief & Loss Low Self Esteem
Marital/Relationship Issues Posttraumatic Stress Disorder
Stress Transitions (divorce, job loss, empty nest)
Trauma
Other