Below are typical forms needed or provided at first appointment. To make the intake process quicker, you can print out the forms to fill out and bring with you. Click and download to print and complete.
This requests general contact information, emergency contact, medical information, and consent for treatment services to be received at ALPHA.
This is necessary if any information needs to be shared with other individuals or agencies to ensure any coordination of services needed.
This provides information needed to determine if an individual qualifies for sliding scale fee or other financial assistance to pay for services.
This provides details on how to file a report if they feel they have been mistreated or their rights have been violated while receiving services with ALPHA.
This provides individuals with an understanding of what their rights are as a recipient of services with ALPHA and the agency’s duty to provide quality services with dignity and respect.
This provides each individual with an overview of how information about them and their services may be used and disclosed and how they can gain access.
This provides details on information the agency uses and discloses according to the Health Insurance Portability and Accountability Act (HIPAA) and Federal Regulation 42 C.F.R. Part 2.
Main Office
208 King Street
Camden, SC 29020
803.432.6902
Fax: 803.425.0923
108 East Church Street
Bishopville, SC 29010
803.484.6025
Fax: 803.484.6121
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