Forms

Social services 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 the completed forms.

Please click on the following links to download forms.

HIPAA Release Form
God's Love We Deliver Client Referral Form
God's Love We Deliver Medical Referral Form

All forms can be returned to God's Love We Deliver via mail or fax to the attention of Client Services. The medical referral form must be completed and returned to Client Services within 10 days of completing an intake interview.

God's Love We Deliver
166 Avenue of the Americas
New York, NY 10013

Fax number: 212.294.8198