Social Care Network screening
Self-Screening Form
Answer a few questions about food, housing, transportation, or another need that affects your health. The form gives you a clear place to begin.
What happens next
Share what support you need.
If you submit the form, someone on our team reviews your answers. If you qualify, a care coordinator explains what services or referrals may be available and helps with the next step.
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What happens next
- 01
Complete the screening.
Answer questions about needs that affect health and daily life.
- 02
We review your responses.
If you submit the form, someone on our team reviews your answers.
- 03
Understand the next step.
If you qualify, a care coordinator explains what services or referrals may be available and helps with the next step.