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<br />Does receiving meals improve your health? ______ Yes ______ No <br /> <br />Does meals on wheels help you to continue living at home? _____ Yes ______ No <br /> <br />As a result of receiving meals on wheels, do you feel better? _____ Yes ______ No <br />In the last year, have you worried that you would not have enough money for food? ____Yes ____No <br />In the last year, did you have a problem having food last and you did not have enough money <br />to get more food? ___Yes ____No <br /> <br />Do you prefer your meals ____ Chilled, for you to microwave? ____or Hot? <br /> <br /> <br /> <br />What is your favorite part of the meal? ___Soup/Salad ___Entree ___Fruit ___Sweet desserts <br /> <br />Please tell us why you are getting meals? (check all that apply) ____ Illness/disability/fall <br />____ Low income _____ Cannot cook or shop _____ Recent discharge from health facility <br />______Sheltering in place due to the pandemic <br /> <br />Which other social services have you utilized because one of our client services staff referred <br />you? (Please check all that apply) <br />Fall Prevention and Safety Checks: <br />Life Eldercare Fall  <br />Vital Link  <br />Tele-Care  <br /> <br />Housing: <br />Eden I&R  <br />Oakland Housing Authority  <br />ECHO Housing  <br /> <br />In Home Care: <br />In Home Supportive Services  <br />Public Authority for IHSS  <br />Center for Independent Living  <br />Family Caregiver Alliance  <br /> <br />Transportation: <br />Paratransit  <br />Taxi discount vouchers  <br />Oakland Taxi Up and Go  <br />VIP Rides  <br />No. Oakland Village  <br /> <br />Food: <br />Alameda Co. Food Bank  <br />Mercy Brown Bag  <br />CalFresh (food stamps)  <br />Spectrum Community Meals  <br /> <br />Assistive Technology and Medical Devices: <br />Community Resources for Independent Living  <br /> <br />Center for Independent Living  <br />Rebuilding Together  <br />ReCARES  <br /> <br />Utilities Assistance: <br />CA Telephone Access  <br />Lifeline  <br />Home Energy Assistance Program  <br />PG&E  <br /> <br />Legal Assistance for Seniors  <br /> <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: A2ED9C7D-65CF-43D1-B987-717810848FE5