Forms

Thank you for choosing Upward Call to provide your counseling care.

We consider your choice of us a sacred trust. 

 

For your convenience, we have supplied downloadable client registration

and privacy forms below. If you wish, click on the link, print and complete

the form at home, and bring it with you to your first visit. These will be

used at your initial session and kept as part of your client file.

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• Registration Form - Adult  {18+ years}

• Registration Form - Youth {under 18 years}

• Privacy Form

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If you prefer to complete the forms at our office, please arrive 10 to 15 minutes early to your first appointment, in order to not waste your valuable session time.

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Compassionate Care Fund Application

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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 Fund. You may download and complete our Compassionate Care Fund 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.

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• Compassionate Care Fund Application