Counseling Forms

To speed services on the day of the initial appointment, the following forms may be printed, completed by client or client’s parent/guardian, and given to the Agape receptionist upon arrival at the Agape Counseling Center.

Please arrive with the following forms filled out in hard copy (please do NOT submit via email or fax). The appropriate forms may be DOWNLOADED here:

• Client Intake Packet
• Client Rights and Responsibility
• HIPAA Notification-Clients
• YOUR RIGHTS UNDER HIPAA

VERY IMPORTANT: Please check your insurance benefits.

If you wish to pay for counseling services through your health insurance, we ask that, prior to contacting Agape to arrange counseling services, you call the number listed on the back of your insurance card for “mental health” or “behavioral health” benefits. Ask the representative at that number for the following information pertaining to your out-patient mental health benefits:

1. The name of your “behavioral health organization” (e.g., Magellan, UBH, Value Options, etc.)
2. Your annual deductible amount and date the new year begins
3. Your co-pay amount

Having this information available will speed the process of matching you with the Agape counselor who is best equipped to meet your needs.