Online Forms

WNY Psychotherapy Services has created this online intake form for your convenience. If you choose to fill in your information online, please be aware that WNY Psychotherapy Services does not share your information. We provide couples counseling, marriage counseling, family counseling, and more!

Entry of your information is optional and if you choose not to enter such information, you can call our intake department directly at
716-837-6705. Once your information has been submitted online, we will contact you within 24 hours to schedule your appointment. Please note, the more information you submit, the easier it will be for us to schedule you. Also, please indicate a time and day that works best to contact you. Thank you!

Adult Intake Form
Please click here if you are a patient
18 years and older.  

Child/Youth Intake Form
Please click here if you are a parent requesting an
appointment for a patient 17 or younger.