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WELCOME TO DISABLED RESOURCES CENTER

Group Orientations

Every Thursday at 9:00am • Group Intake for all New Consumers to Disabled Resources Center

Group Intake is a FREE information presentation available to all persons interested in becoming a consumer with Disabled Resources Center (DRC). Come to learn what DRC services you may be eligible for. If you are a current consumer or have attended the group intake within the past 3 years there is no need to attend group intake, simply call in and set an appointment. Intake will last approximately 45 minutes and when possible, an individual meeting will be scheduled immediately following the intake with appropriate staff member. Please refrain from wearing scented products to this and all activities at DRC.

Please fill out the new consumer intake form below:

  • xx/xx/xxxx

  • Please insert your first name here.

  • Please insert your last name here.

  • Please use parenthesis and hyphens and include area code (555) 555-5555.

  • Please insert your email address here.

  • xxxx

  • xxxx

  • Please select one.

  • Please select one.

  • Please indicate service(s) requested by order of need (1 for primary, 2 for secondary, etc. List up to 4):

  • Please select one.

  • How many people live in your home?

  • How many children under 18 years old live in your home?

  • Who should we contact in case of an emergency?

  • Source of Income

  • Enter Dollar Amount ($0.00)

  • Enter Dollar Amount ($0.00)

  • Enter Dollar Amount ($0.00)

  • Enter Dollar Amount ($0.00)

  • Enter Dollar Amount ($0.00)

  • Let us know anything else that we might need to know!

Or click here to download a printable form