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Before You Visit

Client Intake Form

Please fill out this form before your visit so we can better serve you and your family. All information is kept confidential.

Client Information

Client Name *

Date of Birth *

Street Address *

City *

State

Zip

County *

Phone Number *

Email Address

Monthly Household Income

Currently Receiving

SNAPWICBothNone

Additional Household Members

Member 1

Name

Age

Date of Birth

Relationship

Employed?

YesNo

Immediate Needs

Check all that apply:

FoodClothesHygieneDiapersCleaning SuppliesOther

I certify the information above is true and accurate to the best of my knowledge.

Full Name (as signature) *

Date *

All information is kept confidential and used only to serve your family.

"Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me."

Matthew 25:40

Visit Us

101 Griffin Street
Wrens, GA 30833

First Saturday of every month
Every Tuesday: 9:00 AM – 12:00 PM
Other times by appointment

Open to anyone in need of food, clothing, hygiene products, diapers, laundry detergent, dish detergent, and many other various items as available.

706-690-4514

(706) 690-4514 By contacting us via SMS with your mobile number, you consent to receive text messages from Hands & Feet Missionary Outreach, Inc. Msg & Data rates may apply. Reply "STOP" at any time to opt out.

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