Start Your Intake
Whether you are exploring services for the first time or looking for the right fit for your family, the intake form is the best place to begin. Share what you know so far, and our team will guide you toward the most appropriate next step.
You do not need to know the exact service or payment option before getting started. Complete the form with the information you have, and we will help with the rest.
What to Expect After You Submit
Step 1 - Your information is reviewed
Our team reviews the details you provide to understand your concerns, goals, and support needs.
Step 2- We follow up with the next steps
A member of our team will contact you to discuss your inquiry, answer questions, and guide you through the next step in the process.
Step 3 - We help determine fit
Based on the information provided, we help identify whether the best path forward is direct services, caregiver support, consultation, or another appropriate option.
Complete Your Secure Intake Form
Our website intake form collects basic contact, insurance, and service information so our team can review your needs and begin benefits verification.
The full IntakeQ packet will be provided later as part of the assessment process.
Share the information you currently have. This short intake helps our team review services, insurance, and next steps.
Your Information Is Handled With Care
Information shared through this form is used only to help our team understand your inquiry and guide next steps. Please do not include highly sensitive medical or personal details beyond what is needed for us to understand your support needs and contact you appropriately.
Need Help Before Submitting?
If you have questions before completing the intake form, feel free to reach out directly.
Contact Info
Phone: 817-382-1897
Email: Intake@affirmativeparenting.com
Fax: 817-549-5062