Client Merge Request
Please answer all questions before submitting your request. Verify the correct information with the client if possible but please DO NOT enter any identifying client data, HMIS IDs only.
Email address *
Requester's Name *
Your answer
Agency
Your answer
Client ID to keep active (if possible) *
Your answer
All other Client IDs to be merged *
Your answer
Are all profiles unlocked (as noted by the green lock icon)? If not, these profiles cannot be merged *
Captionless Image
Is the client's name spelled consistently on all profiles? If not, please indicate which Client ID has the correct information (DO NOT ENTER CLIENT'S NAME HERE) *
Is the SSN consistent on all profiles? If not, please include the correct SSN. If not, please indicate which Client ID has the correct information (DO NOT ENTER CLIENT'S SS# HERE) *
Is the client's date of birth consistent on all profiles? If not, please indicate which Client ID has the correct information (DO NOT ENTER CLIENT'S DATE OF BIRTH HERE) *
Is the client a U.S. military veteran? *
Thanks for taking the time to fill out this form! You will be notified when the merge has been completed.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Raleigh/Wake Partnership to End Homelessness.