Malta, NY (518) 289-5072
Niskayuna, NY (518) 374-6263
Become a Patient
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Thank you for your interest in becoming a Union Street Counseling patient! Get started by following 3 simple steps:
Download and save the form to your computer
Fill out your form using a PDF editor
Attach your document to the form below to submit
The Intake Form allows for proper assignment to a private provider who participates with your insurance and will best be able to assist.
Processing the Intake Form and assigning the patient to a provider usually takes 5-7 business days.
Submit your form
Fill out the fields below and attach your completed Intake Form PDF.