New Clients

If you are a new client, please complete the following forms and bring them to your first scheduled appointment.

 

 

 

New Client Form (4 pages)

 

Consent for Treatment (2 pages)

 

Minor Child Consent for Treatment (1 page)

 

 

If you would like me to coordinate care with another provider (for example your psychiatrist, primary care physician or prescribing psychologist), complete this form to authorize the release of psychotherapy information.

 

Authorization to Disclose Information Form

 

 

 

Note: To download Adobe Acrobat Reader for free, please go to:

 

http://get.adobe.com/reader/

MaryEllen Agolia, PhD, DSS

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MaryEllen Agolia, PhD, DSS

M.A. in Social Work, LPCC, PhD,

Doctor of Spiritual Science

Counseling Services

 

Client Testimonials

 

"Mary Ellen is a wonderful counselor to have had in our corner during my childs' difficulties in school.  She helped with the IEP and attended the school meetings with our family."

"Dr. Agolia is someone I would recommend to family or friends.  I had a problem using my EAP during my divorce.  She helped me through a very tough time and worked with my insurance."

"When I was in the hospital and couldn't come into the office Dr. Agolia came to my room.  It meant so much to me."

"If you need a counselor Dr. Agolia is the way to go.  My insurance lets me see as many counselors as I want until I find the right fit.  It took 3 appointments with 3 other counselors in Alamogordo before I found the right one.  Dr. Agolia  is caring and gave me more information on that first day than I had from the other 3 counselors combined."

MaryEllen Agolia, PhD works with the following insurance carriers:

I'm contracted as an in-network provider with many insurance carriers.  Out-of-network services may also be available according to your benefit plan.  Please check your policy for behavioral health benefits and contact me with any questions.  I'm always willing to work with your insurance.

 

​© 2019 by MaryEllen Agolia, PhD

  All rights reserved.

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