>>LifeNet Questionnaire

Please answer the questions below in as much detail as you can. Checking one or more of the boxes does not disqualify an applicant from consideration. Rather, this will help us learn more about the adult’s past and present circumstances and determine whether LifeNet is capable of supporting them at this time (and if so, how we might prepare). 

 
Thank you for sharing this information. If we need more, we’ll ask. Again, we will use this information to determine whether the adult’s level of need falls within our ability to provide effective case management services. If not, we will make every effort to refer the adult to a more appropriate provider, program or service. We will let you know as soon as the determination is made.

Sincerely,
The LifeNet Team

Click here to return to the LifeNet page.