Get Food & Friends Client Intake Form 2023-2025

Filling out the Food & Friends Client Intake Form online is a straightforward process that allows users to access crucial nutrition services. This guide offers clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the intake form.

1. Press the ‘Get Form’ button to access the Client Intake Form and open it in your document editing tool.
2. Begin with the Client Services section, where you will need to provide the client's first, middle, and last names along with their date of birth. Ensure that you fill in this section clearly.
3. Indicate whether the client has received services from Food & Friends previously by selecting 'Yes' or 'No'.
4. Complete the client's email address and home address, including city, state, and zip code. Provide a contact number and indicate consent for text message alerts regarding deliveries.
5. Fill out the Demographic Information section, selecting options for gender, ethnicity, race, veteran status, and primary language. All fields are mandatory.
6. In the Services Needed/Treatment Plan section, select whether the client requires Home-Delivered Meals or Groceries-to-Go. Choices include specifying the meal plan and any dietary restrictions.
7. Move to the Household and Family Information section, confirming whether the client lives alone or with others. Detail the total number of household members and complete the required information for each member.
8. In the Providers and Relationships section, provide the names and contact information for the client's case manager and physician, ensuring you check all required boxes regarding their awareness of the client’s status.
9. Complete the Household Income and Insurance Information section, listing all sources of income and insurance coverage. This information is necessary for compliance.
10. If applicable, fill out any additional information corresponding to specific client types based on illness or treatment details.
11. Complete the Activities of Daily Living and Compromised Nutritional Status sections by checking all that apply.
12. Finally, review all entries for accuracy before saving your progress. Once completed, you can save changes, download, print, or share the form as needed.

Begin filling out the Food & Friends Client Intake Form online today to access vital support services.