Thank you for choosing Upward Call to provide your counseling care.
We consider your choice of us a sacred trust.
For your convenience, you may fill out your Intake Application
online by clicking on the appropriate link below. In addition to the
Intake Application, both the Privacy and Policy Forms should be
filled out, along with the Consent to Treat a Minor Form
(if Youth Client is applying).
One Intake Application per client only. If you are interested
in couples counseling, each partner must fill out separate Intake
Applications, Privacy, and Policy Forms.
These forms must be completed before an appointment can be scheduled.
These are used at your initial session and kept as part of your client file. If you have any questions, please contact our office at firstname.lastname@example.org or 717.656.4834.
ADULT FORMS (18 + Years)
Please note: All three forms below must be completed before an appointment can be scheduled.
YOUTH FORMS (Under 18 Years)
Please note: All forms below must be completed before an appointment can be scheduled.
COMPASSIONATE CARE PROGRAM APPLICATION
It is our desire to minister to people, regardless of their ability to pay. Therefore, we offer services on a "sliding scale" through our Compassionate Care Program. You may download and complete our Compassionate Care Program Application below to apply for this assistance, or request the application from our office at 717.656.4834.
In order to qualify for a reduced rate and along with your completed application, you will need to submit proof of household income to our office. The reduced rate will apply only to services received after the reduced rate has been approved.