Agape welcomes Providers looking to refer New Patients, as well as New Patients and their families.
New Patient Referrals
New patients can be referred to Agape Youth Behavioral Health by any Primary Care Provider, Medical Specialist, or Therapist.
New patient referrals can be faxed to (423) 464-7631. They must include the reason for referral, types of services requested, patient information, insurance information, and any other pertinent information.
Our standard referral form is linked below. We evaluate referrals on a case-by-case basis and will try to respond within 1 week of referral.
Once you have been accepted as a new patient to our clinic, you may download and complete our New Patient Pack of forms (linked below).
These should be completed prior to your appointment. You can bring them with you to the initial appointment or fax them ahead of appointment to (423) 464-7631. Please also download and review our Privacy Practices.
If you were referred concerning ADHD or you are concerned about ADHD, the Vanderbilt Assessment Forms can be downloaded and completed. While these are not required for the initial appointment, they can be helpful. Please have both a parent/caregiver and a teacher complete the respective forms.
Payment of all co-pays, co-insurance, and deductible amounts owed is expected at the time of service. You will be provided with an estimated amount owed at check-in. Depending on circumstances, Agape Youth Behavioral Health will occasionally agree to payment plans for services. If requested, please download and complete the following form:
We are on panel for most insurances – although this varies some by provider. We are currently accepting new patients for all insurances except United Health Care’s Tenncare Community Plan. We are currently unable to take new referrals for other forms of Tenncare at this time, but are still able to provide medication management and will assist in connecting with one of our partners for therapy.
Our base rates range from $175-250 for new patients and $110-300 for follow-up visits (depending on the provider and length of visit). We are sometimes able to negotiate slightly lower rates for cash paying patients who pay in full at the time of the visit.
We see all ages! We generally see all children from age 5+ and adults 18+. We will occasionally accept new referrals under age 5 depending on circumstances and diagnosis.
Steps for accessing the Agape Patient Portal:New Users:Sign a Portal Access Consent Form and Bring/Fax it to Agape ((423) 464-7631 – Make sure your email address is correct on the form.You will receive a registration email – click the link in this emailCreate a username and password (remember these!)You will receive a confirmation email – click the link to confirm your email addressEnter your passwordRead and agree to the terms of use for the Patient PortalExplore the features of the portal!Returning Users:Go to https://patientonlineportal.com/Enter your username and passwordExplore the features of the portal!
All refills are sent to the pharmacy by the end of the following business day after they are requested. You can check with your pharmacy which should have record of the refill by the end of the following business day. If your child’s medication will run out over a weekend, please request a refill by Thursday to ensure that it is filled before Monday.
The majority of our providers are always accepting referrals and evaluate these on a case-by-case basis. We do not guarantee accepting all referrals for new patient appointments. We will generally suggest an appropriate alternative if we are unable to accept a referral for a new patient appointment.
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