Virtual Groups

In light of COVID-19, we have partnered with HALO Project, Pivot - A Turning Point for Youth, and the Arnall Family Foundation to meet the current needs of Oklahoma's families in need of mental health support and families raising children whose parents are currently incarcerated. If you need support during this difficult time, please sign up below.

Child Information

Child Intake Assessment

First Name:

Last Name:

Empower Location:

Preferred Name (if different):

Date of Birth:

Gender:

Address:

State:

Zipcode:

Race (mark all that apply):

Language:

Ethnicity:

Family Composition (Mark all that apply) :

Parent/ Guardian First Name:

Parent/Guardian Last Name:

Middle Initial:

Preferred Name(if different):

Relationship to Child:

Phone Number:

Email:

Best way to contact:

Best time to contact:

Address:

City:

State:

Zipcode:

Fears we should be aware of:

Any event in your child’s life that may have been particularly upsetting:

Social or emotional characteristics you would like to note:

Other conditions requiring special care or additional information you feel would be helpful:

Informed Consent

Lilyfield is providing virtual support groups and as well as Kid and Youth Club. Groups are psychoeducational in nature and are not intended to be therapy for major mental health challenges. Trauma informed methods are used to guide services. Lilyfield does not provide transportation to clients. No service will be provided without parent/guardian consent. Lilyfield virtual group services are voluntary and there is no cost to you or your family. You are free to limit or end services at any time. Please download and read the form, once finished fill out the form below. By clicking the "agree" button, you agree to Lilyfield's terms and conditions listed in the Informed Consent document.

Informed Consent

Informed Consent Acknowledge Form

Notice of Grievance

Lilyfield wants to ensure that all clients are ensured fair consideration of complaints made by clients, including children, and guarantee a quick resolution to any complaint. You have a right to file a grievance, receive written response to your grievance and to appeal if you are not satisfied with the response you get. You have a right to report allegations of abuse, neglect, and mistreatment. If anyone attempts to deny you these rights or causes you problems in filing a grievance, contact your Grievance Coordinator immediately. Please download and read the form, once finished fill out the form below. By clicking the "agree" button, you agree to Lilyfield's terms and conditions listed in the Notice of Grievance Right document.

Notice of Grievance Right

Child Intake Assessment

Informed Consent Acknowledge Form

Notice of Grievance Right Acknowledge Form

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