You're one step closer...to a brand new you.
Couple Smiling at Each Other

Helpful Forms

If you will be using Health Insurance as part of you payment, please review and complete the Agape Counseling Center Forms and bring them to your first session.

    Insurance Packet under construction


If you will be paying by cash or check, please review and complete the following forms, bring them to your first session.

  • Client Intake Form
  • Limits of Confidentiality/Cancellation Policy Form

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

  • Consent to Release Information Form

 

Client Intake Form  
Confidentiality and Cancellation Policy  
Consent to Release  

Note: To download Adobe Acrobat Reader for free, click here.


Schedule Appointment

Start your new path in life and be the change today!

CLICK HERE
Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE