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Holding Hands Support

Need Trauma Support? We’re Here to Help. 

Reaching out takes courage — and you’ve just taken a powerful first step.

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EmpowerED Outreach partners with trusted mental health professionals to provide no-cost trauma therapy for children, teens and adults in Texas. 

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This form helps us learn about your needs so we can match you with the right provider. 

A member of our team will contact you within 48 hours before submitting your referral. 

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You deserve to feel supported, safe, and seen. 

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We’re here to walk beside you. 

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🚨 Crisis Disclaimer

 

EmpowerED Outreach does not provide emergency or crisis services. 

If you are in immediate danger or experiencing a mental health emergency, please call 988, or contact your local emergency services right away. 

Before You Begin

 

Please note: 

  • This form does not schedule a therapy session. 

  • You will receive outreach from an EmpowerED coordinator first. 

  • Services are currently available for Texas residents only. 

  • Minors will require caregiver or guardian involvement. 

EmpowerED Outreach — Therapy Referral Intake Form 

SECTION 1 — Personal Information 

Date of Birth
Month
Day
Year
Are you completing this form for yourself or for a minor?
Myself
A minor (child/teen)
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