Get Started

Start your journey with Empowerment.
Hope starts here...Welcome!

Step 1

Watch the WELCOME Orientation Video

Step 2

Fill out the Pre-Intake Form
or Call 720-425-6293

Step 3

An Intake Specialist will contact you in the next 24 hours, or as soon as possible

PRE-INTAKE FORM - Contact an Intake Specialist to Enroll

* Indicates required field

Name *

First

Last

Date of Birth *

Month/Day/Year

Gender Identity *

cisgender - your gender matches your assigned birth sex

What Pronouns Do You Use? *

Race *

African American / Black American Indian or Alaska Native Asian Caucasian / White Native Hawaiian or Other Pacific Islander Other

Ethnicity *

Phone Number *

If you do not have a phone number, please leave a number where you can be reached

OK to Leave a Message? *

Yes No

Email *

No e-mail? Get one at Gmail.com
G-MAIL

Address *

Line 1

Line 2

City

State

Zip Code

Country

If you are homeless, please write homeless, and County

What services are you interested in? *

Mental Health Group Therapy Substance Use Group Therapy (non-DUI) *Brief Individual Therapy Services for people who inject drugs Services for people involved in sex work HIV Prevention and Testing PrEP Navigation Care Management for people living with HIV Re-Entry Services

check all that apply

* Please note, there may be a waitlist for Individual Therapy

How did you hear about The Empowerment Program? *

Friend / Family member Healthcare Provider Probation / Parole Officer Website / Internet Outreach Provider Flyer / Brochure Other

check all that apply

If Other: *

Are you on Parole? *

Yes No

Are you on Probation? *

Yes No

If you were recently released from PRISON. when were you released? *

If you were recently released from JAIL, when were you released? *

If you were in the RISE Unit at Denver County Jail, when were you involved in the program? *

Comment *

Referring Agency Release of Information *

Max file size: 20MB

Submit

Any questions or concerns about enrolling, please e-mail our Intake team: intake@empowermentprogram.org

E-Mail

If you are an agency provider want to make a referral, click HERE.

Make a referral

If you are only interested in HIV testing and do not wish to sign up for the program, click HERE.

I want to get tested for HIV

OUR MISSION: Holistically helping individuals build healthier lives from the inside out.

Get Tested

Get Started

The Empowerment Program
1600 York Street
Denver, CO 80206
303-320-1989
FAX: 303-320-3987

COVID Vaccine Info

Wellness Challenge

Groups & Classes

Start your journey with Empowerment.Hope starts here...Welcome!

Step 1

Watch the WELCOME Orientation Video

Step 2

Fill out the Pre-Intake Form or Call 720-425-6293

Step 3

An Intake Specialist will contact you in the next 24 hours, or as soon as possible

PRE-INTAKE FORM - Contact an Intake Specialist to Enroll

Start your journey with Empowerment.
Hope starts here...Welcome!

Fill out the Pre-Intake Form
or Call 720-425-6293