[2][3] It was formed from portions of the Presbytery of Ohio by the Synod of Pittsburgh on October 19, 1819, at a meeting at Three Ridges (later West Alexander).
Representing a territory of more than six thousand square miles, the new Presbytery was composed of nineteen congregations: Cross Creek, Mill Creek, Flats, Cross Roads, Three Springs, Upper Buffalo, Lower Buffalo, Upper Ten Mile, Lower Ten Mile, Three Ridges, Short Creek, Forks of Wheeling, Wheeling, East Buffalo, Wolf Run, Unity, Wellsburgh, Waynesburgh, and Crab Apple.
Services were already regularly being held at churches in Claysville, Waynesburgh, Wellsburgh, and Wheeling.
[4] By April 1821, communicants in the new Presbytery numbered 1,659, and the amount donated for missionary support was $560.83.
As part of this change, the churches of Bethel, Hughes River, Pennsboro, and Sistersville were transferred to the West Virginia Presbytery.