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Empowered Services

Corporate Office

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

Phone Number

503-855-3581

Start Customer IntakeCreate Caregiver Profile
Start Customer Intake
Create Caregiver Profile
Oregon Disability Support · Customer Intake

Let's build a care team around what matters.

Tell us about the child or adult who may need support. Empowered Services welcomes intake from all 36 Oregon counties. A member of our care team will usually follow up within 1–2 business days to learn what you need and help identify the next step.

We use your county, requested schedule, goals, routines, communication style, and caregiver preferences to help understand the right next step.

County Schedule Goals Routines Communication Caregiver choice Next step
Confidential intake
Usually 1–2 business days
All 36 Oregon counties welcome
No pressure · No commitment
Statewide certified. Intake is welcomed from all 36 Oregon counties. When services can begin depends on authorization, the support needed, agency capability, and qualified staffing availability.
Step 1 of 5

About you

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

Who's filling out this form? *

Our regular care-team hours are Monday–Friday, 8am–5pm PT. Share limited availability and we will do our best to coordinate.

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

Step 2 of 5

About the person receiving support

If that's you, we can use your name from Step 1. If you are requesting support for more than one person, please submit a separate form for each person so each request and follow-up stays clear.

Is this the same person as you? *

Initials are fine for privacy.

Used to confirm the person and apply age-specific service rules.

Helps us match the right Care Coordinator to your area.

Step 3 of 5

Services, caregiver choice & schedule

Help us understand where you are today. It is okay to be unsure — we will help you identify the right next step.

Are Oregon I/DD services already set up? *

Note: Empowered Services is a Medicaid/ODDS-funded provider agency. We do not determine I/DD eligibility or authorize services or hours, and we do not currently offer private-pay services.

Current DSP or PSW situation *

From your CDDP, Brokerage, or referring agency.

What support are you interested in? *

Choose all that apply. Your Individual Support Plan (ISP) and authorization determine which services can be provided.

Day Support Activities and Community Transportation are adult services. If the person receiving support is under 18, those choices will be unavailable.

Do you already know someone you would like as your caregiver or DSP? *
What schedule are you looking for? *

Enter at least one day and time that would work best right now, or choose “I do not know the schedule yet.” It does not need to be final. Your Individual Support Plan (ISP) and authorization determine approved services and hours; this helps us understand the schedule you are trying to fill.

Day Support? First time Second time Split shift
Monday
to
Tuesday
to
Wednesday
to
Thursday
to
Friday
to
Saturday
to
Sunday
to
Requested schedule: No times entered yet This is a planning estimate, not an authorization.
Who would you like as your Empowered Choice caregiver?
You choose the person you trust. Empowered Services handles the agency and employment steps, including paperwork, credential and background checks, hiring, required training, and pay setup. The person you choose must complete the required employment and program steps before paid support can begin. Start with their name if that is all you have today. If you share their phone or email, please make sure they are comfortable with you giving us their contact information.
Next step for each caregiver you choose

Please ask each person you name here to submit Empowered Services' official caregiver application. They can apply now or after you finish this intake. Submitting an application starts the employment review; it does not guarantee hiring or a service start.

Start Official Caregiver Application →
Primary caregiver

Each preferred caregiver must complete the official application and all required employment, credential/background check, onboarding, and training steps before starting paid work. Empowered Services will guide them through the process.

When are you hoping to start? *
Step 4 of 5

What helps support work in real life?

This step is optional. You can share matching preferences now or continue and talk through them with the care team later.

Add matching preferences Optional — skip this for now if you prefer.
How we use this: We look at comfort and connection, routines and rhythm, communication, goals and participation, language and cultural context, schedule and location, and support style. Person-centered preferences matter. Protected traits are not used as shortcuts for skill, safety, or fit.
01
Comfort and connection
What helps the person feel respected, comfortable, and able to build trust with a caregiver?
02
Routines and rhythm
Timing, habits, flexibility, transitions, and household flow can make support feel easier or harder.
03
Communication
How does the person communicate, process information, and show what is working or not working?
04
Goals and participation
What does the person want to keep doing, learn, experience, or do more independently?
05
Language and cultural context
Communication preferences, household norms, cultural context, and traditions can help support feel respectful and natural.
06
Schedule and location
We already asked for exact days and times. Where support happens, transportation, travel, and setting also affect real-life fit.
07
Support style
What kind of prompting, coaching, structure, or hands-on support tends to work best?
Important instructions or readiness needs
You do not need to upload plans here. This only tells the care team what may need to be reviewed during onboarding. “None known right now” and “Not sure yet” are stand-alone choices.
Is support needed soon?
These answers help the care team prioritize follow-up. A preferred start within two weeks is not automatically treated as an emergency.
Practical matching considerations
Share practical needs that may affect whether a DSP can safely and realistically support the person.
Anything else we should know?
Share anything else that would help us understand the person, their support needs, preferences, accommodations, or what a good day looks like.

0 / 2000 characters

Step 5 of 5

Almost done.

Last couple of details — and you're done.

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

Ready when you are. Your form goes directly to our care team. After a successful submission, you will see an on-screen confirmation. We also send a confirmation email, and a team member will usually reach out within 1–2 business days.

What happens next

  1. Instant confirmation
    You'll see a confirmation page right after a successful submission. We also send a confirmation email. If you do not see the email, check spam; the on-screen confirmation is the primary signal that your form went through.
  2. Your care team reaches out
    Usually within 1–2 business days, using your preferred contact method.
  3. Discovery conversation
    A conversation to understand goals, preferences, authorization status, and what matters in everyday life.
  4. Plan the next step
    If you already know the person you want as your caregiver, ask them to submit the official Empowered Services caregiver application and we will guide the remaining employment and onboarding steps. If you need help finding a DSP, we can begin the matching process. Timing depends on authorization and qualified staffing availability.

We protect your information.

Information submitted through this form is used by Empowered Services' care team to review your request, follow up, and coordinate appropriate next steps. Intake information is handled through authorized systems. We do not sell, trade, or share your information with third parties for marketing.

503-855-3581 intake@empowered-services.org Privacy policy
Call for help Call (503) 855-3581