Intake Form

Is this an emergency that requires an immediate response? If yes, please call 911 or crisis services in your county, or go to your nearest emergency room.

Thank you for using FCA’s Online Intake Form to quick-start the intake process. FCA’s Intake Coordinators will call you back to complete the form at your preferred time between 9 to 4 PM, Monday-Friday, to match you with the best available therapist.

When might be the best time to call you back to complete the intake process?

Please describe in detail
The more options you provide, the better the chances of getting you in quickly

If you experience any difficulty submitting this form, kindly call our Intake Coordinators at 716-836-9460 ex 205. Thank You.

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