MOBILE DIAPER PANTRY PROGRAM – CLIENT INTAKE FORM & DISTRIBUTION POLICY FOR INCONTINENCE PRODUCTS
Online registration is required at least 24 HOURS PRIOR TO YOUR FIRST VISIT TO ANY DISTRIBUTION DAY. If you are not on our registered client list when you arrive at a distribution, you will not receive diapers.
All individuals 65 years of age and older automatically qualify for the program. Please bring your Medicare and/or Medicaid card with you to your first visit.
For individuals 5 - 64 years old and/or with special needs, the following documents must be provided at your first visit:
* Photo ID (caregivers must provide ID for themselves and the recipient of the supplies)
* Proof of date of birth
* Prescription of incontinence or IEP/doctor's note with diagnosis
Clients can only visit 2 locations each month and not twice in the same week.
Why do we ask families to register?
Registration helps us serve you better, make sure we have enough diapers available and gather the information necessary to expand this program to more families. We are also required to report on our diaper distribution to grant funders and the National Diaper Bank Network (NDBN). Keeping Families Covered will keep your information private. We will not share your name, address, phone number, email address, or personal information. Data reported to funding agencies and the NDBN will only include group demographics (i.e. % of military families, etc.). Each individual and/or family that registers and visits the mobile diaper pantry will receive free disposable diapers and wipes. The quantity of diapers provided is subject to change at any time without notice. Wipes may not always be available.
We only distribute incontinence products on the designated mobile pantry days. The schedule with dates, times and locations is available on our website under Mobile Diaper Pantry.