Crab Care (DEMO) | Sherpa Care Guide

We Ask Because We Care

We focus on the whole person. By uniting cutting-edge science with a keen understanding of your individual needs, we strive for the most effective care possible. To do this, we'd like to learn about any challenges you're facing that could affect your treatment.

By linking patients to critical resources such as housing assistance, food security programs, and transportation solutions, we aim to make a tangible impact on their lives. This initiative is an integral part of our ongoing dedication to fostering an inclusive environment where everyone has equitable access to the opportunities they need to achieve optimal health.

Are you Hispanic or Latino?

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Which race(s) are you? Select all that apply

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At any point in the past 2 years, has season or migrant farm work been your or your family’s main source of income?

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Have you been discharged from the armed forces of the United States?

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What language are you most comfortable speaking?

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How many family members, including yourself, do you currently live with?

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What is your housing situation today?

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Are you worried about losing your housing?

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What address do you live at?

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Street Address (required)

City (required)

State (required)

Zipcode (required)

What is the highest level of school that you have finished?

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What is your current work situation?

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What is your main insurance?

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During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits

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In the past year, have you or any family members you live with been unable to get any of the following when it was really needed? Check all that apply.

Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?

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How often do you see or talk to people that you care about and feel close to? (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)

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How stressed are you?

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In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?

Are you a refugee?

Do you feel physically and emotionally safe where you currently live?

In the past year, have you been afraid of your partner or ex-partner?

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We Ask Because We Care