New Client Forms

• We do NOT accept Employee Assistance Program (EAP) Plans. Unfortunately, we still show up on a number of insurance websites. We're sorry about this!
• We can NOT prescribe medications.
• We do NOT complete psychological evaluations to determine learning disabilities.
• We do NOT schedule evening or weekend appointments. All appointments are week days during the day.We have in-person appointments, but not all providers will be in-network.

• Contact information for your Primary Care Physician
• Current List of Medications and Allergies
• If using health insurance benefits, Health Insurance Card (front/back pictures)
• For individuals subject to a court order or custody document, Court Documents
• For minors, Divorce, Custody Decree, Child Support Orders, etc.
• For adults, Guardianship Orders

If at any point during the online form, you receive a pop-up that we are not a good fit, please do not proceed with signing consent forms. We provide screening questions to be respectful of your time as you look for a provider.

Release of Information

A Release of Information Form allows us to disclose information with another provider. We encourage collaboration between our agency and other professionals involved in your care.

Your may
 1.Complete the Release of Information form online OR
 2.Download the PDF and send the completed forms with a copy of your photo ID through fax or email.

Please fax these forms with a copy of your photo ID to 817-405-3362 or email referrals@empathyhq.org‍

2023 Consent Forms/Policies

2023 CONSENT FORMS/POLICIES

Custody Clarification Forms

CUSTODY CLARIFICATION FORM

Agency Policies & Procedures

These forms are referenced in our updated New Client Forms and are available for review here on our website at any time.  Clicking on the button will download a PDF copy of the current form.

EmpathyHQ PRACTICE POLICIES

For Existing Clients signing into the Client Portal:
‍

IntakeQ Client Portal

For Clients needing to upload forms to their New Client Forms *OR* through this portal, existing clients can make or reschedule an appointment, access forms sent by your Therapist, or send a message to our Staff.