Personal care for a personal town.
Monday – Friday: 8:00 AM - 4:30 PM Saturday and Sunday: Closed Closed on Major Holidays
Our goal is to provide the best possible care for your child and family. This screening will ask you some non-medical questions to help us better understand any needs you may have and connect you with available community resources. Most of these resources are free of charge.
"Social Needs Survey" should only be filled out of the patient has Cigna, Health Choice, Mercy Care or United Healthcare Community Plan as their primary insurance.
In the past year, did you ever eat less than you felt you should because there wasn’t enough money for food?
Does transportation keep you from medical appointments, work, or from getting things you need?
Are you worried that in the next 2 months, you may not have stable housing?
Do problems getting child care make it difficult for you to work or study?
Do you feel physically or emotionally unsafe where you currently live?
In the past year, have you been afraid of your partner or ex-partner?
Do you feel unsupported by those around you? (friends, family, church, etc.)
Do you feel overly stressed? (tense, nervous, anxious, or can’t sleep)
In the past 6 months, have you or anyone you live with been unable to get any of the following?
If you answered ”Yes” to any boxes above, would you like to receive assistance with any of these needs?
Are any of your needs urgent? (For example: I don’t have food tonight, I don’t have a place to sleep tonight)
22707 S Ellsworth Rd, Suite H101 Queen Creek, AZ. 85142 (near Ellsworth and Ocotillo Rds)
Fax: (480) 792-9206
Monday – Friday: 8:00 AM - 4:30 PM Saturday and Sunday: Closed
Closed on Major Holidays
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