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CalLINKS
Intake form
Help us serve you better
Name
*
Email address
*
What is your age group?
Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
What type of services are you seeking?
Please select at least one option.
Healthcare Services
Mental Health Services
Substance Abuse Treatment
Housing Assistance
Food Assistance
Employment Services
Legal Aid
Transportation Services
Do you have any specific health conditions?
What is your preferred language?
Select
English
Spanish
Mandarin
Vietnamese
Tagalog
Arabic
What is your current living situation?
Select
Homeless
Temporary Housing
Permanent Housing
Living with Family/Friends
How did you hear about CalLINKS?
Please select at least one option.
Referral
Social Media
Website
Community Event
Please provide your zip code.
Additional questions or comments
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