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Please complete the Empowering Individuals, inc. forms as instructed.

INTAKE APPLICATION

Please make sure you fill out this form BEFORE you book your session.

This form DOES NOT include payment. So if you haven’t been referred or booked a consultation please refer to our booking page.

This intake application helps to provide the basic information needed for an accurate adjustment to the program to make ensure success by completion.

PRE SURVEY

Complete this form BEFORE participating in the program.

This survey is designed to help your counselor see where you currently are and how you got there so that there’s an understanding of how to get you where you want and need to be.  It is REQUIRED that this form is completed along with the intake application before actually participating in the program.

POST SURVEY

Complete this form AFTER you have participated in the program.

Once your program is completed, please take the time to fill out this form so that we can see if you were able to achieve success and if there’s any room for improve within the program.

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