Helpful Forms: Therapy Counseling and Psychotherapy

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For more information and/or to schedule an appointment:

Agape Psychological Consortium, PLLC

Office #: (336) 855-4649
Fax #: (336) 855-4645
2211 W. Meadowview Rd.,
Suite 114
Greensboro, NC 27407

agapepsych@yahoo.com

If you are a new client, please print, complete, and bring the following forms to your first session.


Consent Forms (All Clients):
Informed Consent for Treatment Client Rights HIPPA Release of Information
Intake Forms (Adult Clients Only):
Intake (Adult) Problem Checklist (Adult) OQ-45.2
Intake Forms (Child/Adolescent Clients Only):
Intake (Child/Adolescent) Problem Checklist (Child/Adolescent) Burks Behavior Rating Scale

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