New Patient Forms:
The forms below make up the Agape Primary Care new patient package. These forms
are available as downloadable PDF’s that you can print and fill out in the
comfort of your home or office and bring with you for your
first scheduled appointment.
There are a total of 7 PDFs Documents, each one described below with a link - Download, Read, Fill Out, and Bring them with you; Thank you!
There are a total of 7 PDFs Documents, each one described below with a link - Download, Read, Fill Out, and Bring them with you; Thank you!
Acknowledgment of Notice of Privacy Practices:
1 of 7: New patient form to accept privacy policy and practices for Agape Primary Care;
Acknowledgment Page - Download, Read, Fill Out, and Bring with you.
Authorization for Release of Information:
2 of 7: New patient form that authorizes type of information that can be released, who
it can be released to and what form of communication it can be released by;
Authorization Release - Download, Read, Fill Out, and Bring with you.
Authorization Release - Download, Read, Fill Out, and Bring with you.
Clinical Summaries:
3 of 7: New patient form that provides you with the option to receive a summary of your
office visit and your preference on how you would like to receive that
information;
Clinical Summaries - Download, Read, Fill Out, and Bring with you.
Clinical Summaries - Download, Read, Fill Out, and Bring with you.
Health Assessment Form:
4 of 7: New patient form to assess current medical health as well as medical history of
patient.;
Health Assessment - Download, Read, Fill Out, and Bring with you.
Health Assessment - Download, Read, Fill Out, and Bring with you.
Patient Information:
5 of 7: New patient form for your personal information including emergency contact,
primary and secondary insurance coverage and release authorization.;
Patient Information - Download, Read, Fill Out, and Bring with you.
Patient Information - Download, Read, Fill Out, and Bring with you.
Agape Primary Care Inc, Joint Notice of Privacy Practices:
6 of 7: New patient form (Notice) This notice describes how medical information about
you may be used and disclosed and how you can get access to this information;
Privacy Practices - Download, Read, Fill Out, and Bring with you.
Privacy Practices - Download, Read, Fill Out, and Bring with you.
Welcome Letter:
7 of 7: New patient form welcoming you to the practice and some suggestions that will enable Agape Primary Care to serve you better.;
Welcome Letter - Download, Read, Fill Out, and Bring with you.
Ask us any Question about Primary Care:
or Call (800) 411-2427
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The vision of Agapé Senior and Agapé Hospice, Inc. is to help serve our
people in South Carolina with an integrated health services network, and a
primary care presence in strategic markets throughout our beautiful state. Agapé
Senior is recognized as a senior services provider of distinction, which values
its employees and functions with a financially responsible plan and an
empowering environment.