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How To Become A client

NEW CLIENT INTAKE FORM (REQUIRED)

The Women’s Center – Dallas is eager to support all women impacted by chronic illness who live in the Dallas/Ft. Worth metroplex. In addition, our website and educational component allows us to reach women abroad. To receive financial assistance or participate in our programs you must complete our virtual intake form. The rules for receiving financial assistance are below:

  1. Must show proof that you are living with a chronic illness that has impacted your income. You are also eligible if you receive SSI or SSDI income.
  2. Picture ID, proof of Income.
  3. Must complete the intake form before applying for any type of assistance.
  4. Due to HIPAA laws, we do not ask for the specific illness you are living with; however, you should be able to provide proof of consecutive doctors’ visits. A verifiable Case Manager or Social Worker may also serve as your confirmation.
  5. We require a telephone or virtual Intake conversation, for example
    on zoom or by telephone. We want to ensure we have all the information that is needed to process your intake forms and vendor payment information.
PLEASE NOTE:
  • WE WILL NOT ASK FOR YOUR MEDICAL RECORDS.
  • WE WILL NEED TO VERIFY YOU ARE UNDER A DOCTOR’S CARE BY REQUESTING YOU TO PROVIDE A COPY OF RECIPT OF YOUR LAST APPOINTMENT (which should only show your name, date and doctor’s name/office)

The Women’s Center (Dallas)
A place of optimism and hope for women…

Please be mindful:

Our post pandemic operations are primarily virtual, and our physical office is open under reduced hours. Calls are returned primarily by volunteers and in the order they are received (may take up to 5 business days) so please be patient and if you need immediate assistance please dial 911.

Thank you in advance and we look forward to speaking with you soon

New Client /Intake Team