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Seniors Needing Assistance Form
Please fill out this form if you need help in the Sacramento or surrounding areas during lock-down.
If you need immediate assistance, please call 1-855-550-7877.
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* Indicates required question
Name:
*
Your answer
Phone number:
*
Your answer
City:
*
Your answer
Gender of person needing help:
*
Female
Male
What language is the person needing help comfortable with:
*
Your answer
I need help with:
*
Medicine Pickup
Grocery Pickup
Digital Help
Just want to talk
Other:
Required
Please explain below if you need something specific:
Your answer
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