Agape Counseling Center Send Message

Who would be receiving care?

Your info

Select the state you live in
If you have any questions or need assistance at any point, please don't hesitate to reach out. We're happy to help! If you're having trouble with the online booking process or would simply prefer to speak with someone, our friendly front office team is here for you. Please give us a call at **937-434-0540**. Our office hours are Monday–Thursday, 9:00 a.m. to 4:15 p.m. and Friday, 9:00 a.m. to 1:00 p.m. We look forward to helping you get connected with the care you need.
Limited to 600 characters
Reason for care
For example: why you are seeking counseling, what you'd like to focus on, insurance or payment questions, etc.
Limited to 600 characters
Administrative
Enter how you were referred to our services or how you found our services
Client Preferences
Select a clinician from the list

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.