Empowered-Services

inspirations

Corporate Office

8101 SW Nyberg St. Suite: 217 Tualatin, OR, 97062

Phone Number

503-855-3581

Customer Intake

Start Your Care Journey — Empowered Services
Customer Care Intake

Let’s build a care team around what matters.

Tell us a bit about you and the person needing support. A Care Coordinator will be in touch within 1–2 business days with next steps — no commitment required.

Confidential & secure
Response in 1–2 business days
All 36 Oregon counties
No pressure · No commitment
Step 1 of 4

About you

The person filling out this form. We’ll use this to reach you.

Share your preferred language and we’ll do our best to match you with a coordinator or interpreter who can help.

Step 2 of 4

About the person receiving support

If that’s the same as you, feel free to skip the name and jump to location.

Feel free to use just a first name or initials for privacy.

Helps us match the right Care Coordinator to your area.

Step 3 of 4

Current services & support needed

Help us understand where you are today and what you’re looking for. It’s OK to be unsure — we’ll help you figure it out.

Note: Empowered Services is a Medicaid/ODDS-funded agency. We do not currently offer private-pay services.

From your CDDP, Brokerage, or referring agency.

Check all that apply. We’ll tailor our response.

Who would you like as your Empowered Choice caregiver?
If you already have someone in mind, share their information below — a family member, friend, or trusted supporter you’d like to become your paid caregiver. Haven’t decided yet? Feel free to leave this blank and we’ll discuss options on our call.
Primary caregiver
Additional caregiver · Optional
Additional caregiver · Optional

Each preferred caregiver will need to complete a background check and onboarding before starting paid work. We’ll walk them through the process.

Step 4 of 4

Almost done.

A couple of final details so we can serve you better.

First name alone is fine. We’ll make sure they get credit for the referral and can say hello on our call.

Your answer helps us come prepared to our first call.

Ready when you are. Your form goes directly to our Care Coordination team. We’ll reach out within 1–2 business days. If nothing arrives, check your spam folder — or give us a call.

What happens next

  1. Instant confirmation
    You’ll see a confirmation page right after submitting, and a receipt email typically arrives within minutes.
  2. Care Coordinator reaches out
    Within 1–2 business days, using your preferred contact method.
  3. Discovery conversation
    A 20–30 minute call to understand goals, preferences, and what makes this person them.
  4. Match with your team
    We introduce the right Direct Support Professional — someone who fits your life, not just your paperwork.

Your information is safe with us.

Everything you share on this form stays between you and our Care Coordination team. We never sell, trade, or share your information with third parties for marketing. We treat every family’s information with the same care we treat our customers.

503-855-3581 info@empowered-services.org Privacy policy