A Simple Place to Start
You do not need to complete every form on this page before contacting us.
If you are a new client, please begin by submitting a Request an Appointment. Our team will first help you explore clinician availability, scheduling, and payment or insurance questions.
Once you are moving forward with a clinician or service, we will let you know which forms apply to you.
Before You Open a Form
Our online forms use a secure email verification process.
When you click a form link:
Enter your email address.
Follow the prompt to request or copy the verification code.
Check your email for the code.
Return to the form and enter the code to continue.
Please use an email address you can access while completing the form. If you do not see the message, check your spam or junk folder.
If you have difficulty accessing a form, contact our office at 703-881-0121 or info@empowermentmail.com.
New Client Forms
Your intake paperwork helps your clinician understand important background information and gives you an opportunity to review the policies that apply to your care.
Complete only the forms you have been asked to complete.
New Client Intake Packet
Use this form when you have been instructed to complete intake paperwork before your first appointment.
Release of Information
A Release of Information allows you to authorize ETC to communicate with another person or organization, such as a physician, psychiatrist, school, or another treatment provider.
You control whom we may communicate with and what information may be shared, subject to applicable law.
Existing Clients
If you are already receiving services and need to update information, authorize communication with another provider, or complete a form requested by your clinician, use the appropriate link above or contact our office.
Please do not submit a new-client intake packet simply to update existing information unless you have been asked to do so.
Need Help Choosing the Right Form?
You are welcome to ask.
If you are unsure which paperwork applies to you, contact our office before completing forms. We would rather help you choose the correct form than have you complete unnecessary paperwork.
If you have not yet connected with a clinician or service, begin with:
Finding Hope Together.