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Where are you located?
What do you need most?
Groceries to Take Home
Food box or bag to prepare meals at home
Hot Meals
Ready-to-eat meals served on-site
Both Options
I'm flexible and open to either
When can you visit?
Weekday Mornings
Monday-Friday, before noon
Weekday Afternoons
Monday-Friday, afternoon/evening
Weekends
Saturday or Sunday
Flexible Schedule
I can visit anytime
How will you get there?
I Have a Car
I can drive myself
Public Transit
Bus, train, or other transit
Walking Distance
Need to be within walking distance
Need Delivery
Can't leave home
Any dietary restrictions?
No Restrictions
I can eat anything
Vegetarian/Vegan
Plant-based options preferred
Halal/Kosher
Religious dietary requirements
Health Restrictions
Diabetic, low-sodium, etc.
What language do you prefer?
English
Spanish
Other Language
How often will you need assistance?
One-Time Emergency
Just need help this once
Once or Twice Monthly
Regular but limited assistance
Weekly
Need regular weekly support
Not Sure Yet
Depends on my situation
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