Referral Hub
Start a Referral.
Submit a short intake form and our team will follow up within one business day. Full documentation is collected after initial contact — no need to gather everything upfront.
How the Referral Process Works
Submit This Form
Complete the referral and admissions form below with as much detail as you have available.
Intake Review
A member of our intake team will review the referral and reach out within one business day.
Screening & Assessment
We conduct a screening to understand the individual's needs, preferences, and level of functioning.
Service Match
We confirm the appropriate service, waiver eligibility, and proposed start date.
Welcome to ELS
Onboarding begins and the individual is connected with their support team.
New Referral Intake
Provide the basics below. A member of our team will reach out within one business day to guide next steps and collect any additional documentation.
iPrivacy & Information Handling
What we collect: This form collects basic identifying information, waiver type, services requested, and referrer contact details. We do not collect full medical records, Social Security numbers, or financial information through this form.
How it's used: Information submitted here is used solely to initiate the intake process. It is reviewed by Empowered Living Services staff and is not shared with third parties except as required to coordinate services (e.g., your Support Coordinator) or as required by law.
HIPAA & confidentiality: ELS handles all health-related information in accordance with HIPAA and Virginia DBHDS confidentiality requirements. Full documentation — including ISP, LON, health summaries, and behavioral plans — is collected through secure channels after initial contact, not through this web form.
Questions? Contact our intake team at els@empower-va.com or (757) 550-5588 before submitting.
Prefer to Talk First?
Reach Our Intake Team, Intake Coordinator, directly.
Monday – Friday, 8:00 AM – 5:00 PM