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OWCP Intake Request | Federal Injury Behavioral Health
OWCP PSYCHOLOGICAL SERVICES INTAKE REQUEST
This intake form is for federal employees seeking psychological services related to an active or pending Federal Workers’ Compensation (OWCP) claim.
This is not a general therapy intake. Submission of this form does not guarantee acceptance into services.
Please confirm the following before proceeding:
I am a current or former federal employee *
I am a current or former federal employee.
My psychological symptoms are related to a work-related injury or event *
I have an active or pending OWCP claim.
I am seeking OWCP-aligned psychological services, not general therapy.
I understand services are delivered through a team-based provider model
Name *
Date of Birth *
Preferred Phone Number *
Email address *
State of Residence *
GEORGIA
FLORIDA
Federal Agency / Department *
Job Title / Role at Time of Injury *
Current Employment Status *
Currently working
On medical leave
Modified duty
No longer employed
OWCP Claim Number (if available)
Claim Status *
Pending
Accepted
Previously denied
Unsure
Date of Work-Related Injury or Event *
Are you currently receiving psychological services elsewhere? *
Yes
No
If yes: Provider type (therapist / psychiatrist / other)
Are they familiar with OWCP documentation requirements? *
Yes
No
Unsure
I understand that services are delivered by licensed clinicians assigned through a team-based model. I understand that I am not selecting a specific provider. *
I acknowledge and agree
I understand that Federal Injury Behavioral Health provides psychological services only and does not offer legal advice or guarantee claim outcomes. *
Acknowledge
I understand that clinical documentation is completed in accordance with professional standards and OWCP requirements, and may not always align with personal expectations. *
Acknowledge
After submission, this intake will be reviewed for eligibility. If appropriate, you will be contacted regarding next steps. Not all intake requests result in acceptance into services.
Leave this field empty
Submit OWCP Intake Request
