Forms

Social Service Providers:

You must have you client call us directly or sign a HIPAA confidentiality release form in order for our staff to contact them or you to conduct a meal delivery intake. Please send your contact information along with this completed form and fax it to 212-294-8198.

HIPAA Form Letter (pdf)

Home Delivered Meal Eligibility Letter

This eligibility form letter must be completed and sent back to our offices within 10 business days of completing a meal intake.

Eligibility Form Letter (pdf)

Client Referral Form

Things to Keep in mind when referring or becoming a client (pdf)