Church Forms

Welcome to our church forms page! If you are a church, a business or an individual paying some or all of the fee for an Agape client, we’ve included the form to make it easy for you. Please download the appropriate form, have it signed and have the client bring the form with them on their next appointment.

Alternatively, you may scan and e-mail the form to Agape after it has been signed. If you need our e-mail address, please visit our contact page. We must have a signed form before your client meets with a therapist or they will be charged the full fee.

If you are a client or potential client and have landed on this page, we urge you to contact your pastor first before downloading a form.  Many churches have specific policies in place before offering financial assistance.

Other Third Party Payers

Third Party Referral Agreement 2020

If you don’t have one, you may need to download a free PDF reader. Either one of these providers will work:

Nitro PDF Reader