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 Client Intake Agreement 

Welcome to Top Priority Outreach! To provide the best possible care and support, we ask that you complete the Client Intake Form. This form allows us to gather essential details about the client, their background, and specific needs.

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Printable

Version

Fill out, Print or                    Download &

               Send it back!

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Online

Version

Simply,

            Fill out!

                      Online

Hours

Mondays – Fridays:

10:00 am – 5:00 pm
Saturday:

1:00 pm – 4:00 pm
Sunday: Closed

Contact

Email us at:
robert@toppriorityoutreach.com
Give us a call at:
713 090 0343

Houston TX  USA

Disclaimer

Top Priority Outreach does not provide emergency services. If you are experiencing a medical or mental health emergency, please call 911 immediately. Services are provided by or under the supervision of licensed professionals in accordance with state and federal guidelines.

 

Privacy & Confidentiality

We are committed to protecting client privacy and maintaining confidentiality in compliance with HIPAA regulations.

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© 2025 All rights reserved by Top Priority Outreach.

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