Welcome to City Gate Life Recovery

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Thank you for taking the first step with City Gate Life Recovery. Please set aside 5-10 minutes to fill out this brief form so that we can process your information and reach out to you in order to schedule a first appointment.

City Gate is currently partnered with the following insurance providers:

● AARP
● Aetna
● Blue Cross Blue Shield
● Encompass
● Independent Health
● Medicare Part B (has to be primary)
● OPTUM
● Seneca Nation Health System
● Tricare East/Tricare West/Tricare for Life
● United HealthCare
● Univera

Alternatively, City Gate Life Recovery also accepts private pay on a sliding scale based on household income.

At this time, we cannot accept any form of Medicaid, even as a secondary insurance or
Medicaid under an umbrella insurance listed above.

▶ If you are experiencing an urgent mental health crisis, please consider reaching out to the national suicide prevention hotline available 24 hours at (800)-273-8255. If you are a resident of Erie County, you can also reach out to Crisis Services at (716) 834-3131. ◀

Email *

Announcement:

At the moment City Gate offices are undergoing some changes and so we are only able to offer Telehealth appointments at this time, until further notice. We estimate that we should be able to resume hybrid/in-person options to clients by the earliest, October 2022.

Further, we are temporarily unable to accept new clients. However, if you would like to, please feel free to complete the following intake form to be added on our waitlist. Once spots are available, we will be sure to reach out to your as soon as possible.

For any further inquiries feel free to call or text our office at 716-883-7713. Again, if you are experiencing an urgent mental health crisis, please save the hotline numbers mentioned above and call either of them immediately.

Please understand that completing a medical form on behalf of someone else without their consent is illegal. Proceed after selecting one of the following: *

I certify that I am completing this form legitimately, seeking services from City Gate Life Recovery for myself only

I certify that I am completing this form legitimately, seeking services from City Gate Life Recovery on behalf of another WITH their full consent

Please provide your FULL name (this should match what is listed on your medical insurance card): *

City Gate LRC therapist teams specialize in four specific areas of focus. Please select one or more of the following, if applicable, according to your need:

Sex Addiction (Sexually Compulsive Behavior Disorder)

Partners of Sex Addicts

Couples & Relationship Therapy

Substance Abuse or Addiction

Depression and/or Anxiety

Trauma (PTSD and Other)

Other:

Please give us a brief description of what lead you to reach out:

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