Patient Resources

Download Patient Forms

My ADHD Stoplight Tool

A.H.A Lower Your Blood Pressure Form

Blood Sugar Log Form

A.D.A. Dental Form (Part 1)

A.D.A. Dental Form (Part 2)

Self Management Tools

Insurance & Fee Information

Agape Family Health believes that everyone is entitled to affordable health care. No one will be denied access to services due to inability to pay.

Sliding Fee Program FAQ'S

AFH is a “Federally Qualified Health Center.” We offer a Sliding Fee Scale Program that reduces fees on services for qualified patients.

AFH offers a program that reduces fees charged to uninsured patients based on their income and family size. We base patient eligibility for this program on percentages of “Poverty Levels” determined annually by the federal government. Fees are determined either by a minimum fee or a percentage of the full charges. Insured patients may benefit from this plan as non-covered services may also be subject to a fee reduction.

Like every program, AFH has requirements. We acquire specific information from our patients prior to determining eligibility and establishing a sliding fee level based on the Federal Poverty Guideline Determinations are not made until the required documentation has been provided.

In order for you to qualify for our Sliding Fee Scale program, you must fill out an application and provide one (1) of the documents below.

  • Pay stubs (most recent 4 weeks of income) or,
  • Most recent Income Tax Return (attach Schedule C if self-employed) – Expires 04/15 of the  following year or,
  • Workers  Compensation (most recent four weeks of income) or,
  • Unemployment Compensation (most recent four weeks of income) or,
  • Disability or SSI Benefits letter (permanent or temporary) or,
  • Social Security Income or,
  • Documents from local, state or Federal Agency or,
  • Completed Employment Verification (for cash paid household members) or,
  • Notarized letter of Support from family member (when none of the above is available) or a notarized letter stating you have no income or,
  • Any type of documentation that serves the purpose as proof of income or financial status.


Determinations are not made until the required documentation has been provided. 

Agape Family Health Patient Portal

Schedule appointments, stay connected to your providers, and more online with the Agape Family Health Patient Portal! Contact your local Agape location for your login.

COVID-19 in Jacksonville
Testing, Vaccines, & Information

While the spread of COVID-19 may seem to be trending down, high risk communities have been found to be of greater risk to infection. There is increasing evidence that some racial and ethnic minority groups are being disproportionately affected by COVID-19.

Visit our locations page to locate your nearest Agape Family Health Center.

Schedule or change appointments, ask questions, & more. If you are experiencing an emergency, please dial 911.

Visit our contact page for online contact options, important phone numbers, and more.