H.O.P.E Helping Others Prosper Everyday

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Hands of H.O.P.E Screening Questions

Please answer these questions to the best of your ability. It is important that you answer each question with honesty and integrity in order for us to evaluate what is the best care service you are in need of.
Name Date of Birth Select Gender Email Phone Number Diagnosis Are you able to stand and walk on your own? Can you use the bathroom and shower on your own? Case Manager Contact (If Applicable) Current Care Setting What services are needed? Submit