Screening answers
The form collects the answers you choose to provide so we can screen for needs and follow up with you.
Privacy & website information
How we handle your information.
The form is simple and confidential. Share only what you're comfortable sharing about food, housing, and daily needs.
Screening
What the screening form collects.
The Self-Screening Form is hosted on Google Forms. When you use it, Google's terms and privacy practices also apply. OpenDoor Care uses submitted answers only to review needs and follow up.
Contact details
If you include a name, phone number, or email, we use that information only to reach you about your screening.
No ads, no selling
We do not sell your information or use screening answers for advertising.
Who we are
Open Door Care, LLC
OpenDoor Care operates this website for New York Medicaid members seeking Social Care Network screening and navigation support. For privacy questions, email info@opendoorcareny.com.
This website does not approve benefits or services. Final eligibility decisions are made through the Social Care Network program process.
Text messaging
SMS information stays with OpenDoor Care.
If you give permission during a live call, we may use your mobile number to send scheduling, appointment, callback, and care-navigation follow-up texts. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help.
We do not sell or share mobile numbers, SMS opt-in information, or SMS consent with third parties or affiliates for marketing or promotional purposes. We use this information only to provide the customer-care texts you requested and to operate the messaging service.
Read the SMS Terms & ConditionsBefore you begin
Choose what you submit.
Review the questions before you submit. Do not use the form for emergencies—call 911 if you are in immediate danger.
A care coordinator reviews screenings that are shared or submitted and explains possible next steps. This website does not approve services.
Self-Screening Form