If you, a loved one or someone you know has been diagnosed with a life-threatening illness and are unable to independently access healthy food, our home-delivered meal program may be the help you need. Enrollment forms can be found below. If you have any questions or require assistance filling out the forms please do not hesitate to call Client Services at 800.761.8889 or 323.845.1810.
Fill out, sign and send to us all of these FIVE (5) forms. They can be downloaded from this page or call us as at 323.845.1810 and we will mail or email the forms to you. If you reach our voicemail, please leave a message with your name and your telephone number.
Enrollment Forms: Download Here in English / Spanish
Please Note: You must fill out and sign the top of the Eligibility/Consent Form, the rest is to be completed by your doctor.
All forms must be completely filled out in order to be considered for service.
We comply with California State Confidentiality Laws regarding all medical diagnoses and personal information. As such, if a service provider or emergency contact would like to refer a client for service, he or she should fax a confidentiality release form to 323.845.1834.
Once eligibility forms are received and reviewed by our Eligibility committee and a new client is approved for service, a call will be made to conduct an intake interview. We are able to conduct intakes in English and in Spanish. A nutrition assessment, conducted by a Registered Dietitian, is part of the intake process. Special diets are available according to each person's medical requirements.
When you become a client, we will ask you details about contact information, your medical history, any food allergies, list of medications you’re taking and specific details about how to access your apartment or house. This interview can take place in Spanish or English.
If someone does not qualify for our service, information on additional food resources will be provided over the phone.
Once all of your forms have been processed, approved for service, and your interview has taken place, our client services staff will contact you to confirm your delivery date and time.
