© 2023 by AGAPE  Community Health Center. Proudly designed by VXPRO

120 W. Martin Luther King Jr. Dr. 

Washington, NC

Main: 252.940.0602

1130 Godwin Dr. 

Williamston, NC 

Main: 252.789.0401

New Patients

How to become Agape Health Services Patient?

Washington Location:

120 W. Martin Luther King Jr. Dr.

Washington, NC

252.940.0602

Williamston Location:

1130 Godwin Dr.

Williamston, NC

252.789.0401

Come Visit or Call Us at Either of Our Two Locations

First, Call us to schedule an appointment.

 

Your First Visit

When you arrive at Agape Health Services, our front desk staff will guide you through the process.  You will need to fill out paperwork about your health history, insurance information, income, and our privacy policies. We have highly qualified staff that will help you and will answer any questions you may have.  If you have access to a printer, please print the New Patient Registration Packet in English or Spanish (see below) and bring it to your appointment.

Once the paperwork is completed, we will call you back to an exam room.  For a medical visit, our nurse will check your vitals (blood pressure height, weight, and temperature). Other staff will assist you for other types of care such as dental, behavioral health and other specialties and will ask you the reason for your visit. 

Next, you will then meet with your provider (doctor, nurse practitioner or health care team member) who will offer the care you need.

Remember to check out and schedule the next appointment with our front desk staff before leaving. 

What do You need to bring with you?

When you arrive at Agape Health Services for the first time, please bring the following:

  • Proof of Identification (any picture identification card, such as a driver’s license or work ID)

  • Your medications and dietary supplements – bring all your medications and supplements you are taking now.

  • Your medical history – bring any information about past or present health problems, surgeries, family health history, and immunization records.

  • Print the following forms and bring them with you. If you need assistance filling out these forms, please download and bring them to our office. If you have no printer, a copy will be provided for you at our facilities.

 

Agape New Patient Registration Form                                                                 Patient Consent Authorization

 

Authorization to Release Health Information to Third Party                             Self Declaration Form

 

Authorization to Release Health Information Wash                                          Family Practice Health History Questionnaire

                                                                                                                                    HIPAA

If you have insurance:

Proof of health insurance:

Third-party private insurance, Medicaid card, Medicare card. Co-payment (if you have one).

If you don’t have insurance:

Proof of income: the following documents can be used to prove income:

Tax return, W-2’s, one month of paycheck stubs, documentation from an employer of one-month income, court orders, letter from Social Security Office, pension letter, age transcript from the state for unemployment or worker’s compensation. 

  • Arrive 15-30 minutes before your appointment.

Sliding Fee Scale Discount Program Application

Sliding Fee Scale (English) and Sliding Fee Scale Spanish

Payments 

Payment or co-payment is due when services are rendered.

We accept cash, check, all major credit cards and debit cards.

Privacy

Your information and health records are completely confidential.  Our policies comply with the federal regulations under HIPAA (Health Insurance Portability & Accountability Act).  We use an electronic health record system that will store your information in a secure database.  You can see your records, but no one else can unless you grant permission by signing a consent form.  However, by signing the Agape Health Services Consent to Treatment form upon registration, you are authorizing Agape Health Services physicians and staff to access and disclose your medical information so we can better coordinate your care & collect payments from your health insurance company.

Click here to find a copy of the Privacy Notice. Disponible en Español

Other Patient Policies

Controlled Substance Policy                               Patient Complaint Policy