Client Survey We know these times have been especially challenging. Can you take a few minutes to answer a few questions about your current needs so we can continue to provide the best possible food and nutrient supplements for you and your household? If you do not have a client number with Other Options please contact your medical case manager and have a referral submitted to our office. Also, your Client Number and last 4 of your Social Security must match what is on file at our Office. If the information does not match our records the submission is deleted. If you don’t know your client number please contact our office at (405) 605-8020, you will be asked to verify your identity when you call. Please enable JavaScript in your browser to complete this form. - Step 1 of 2Client Number *Last four of Social Security Number (ONLY LAST FOUR) *Email *EmailConfirm EmailYour Cell Phone Number *(Update Your) Home AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNext1. Do you or someone in your household receive SNAP/Food Stamp Benefits? *YesNo2. Which of the following applies to you as a client of Other Options Food Pantry? *The food I receive from Other Options Food Pantry supplements my SNAP/Food Stamp benefits.Other Options is the ONLY resource for food for me and my household.I receive other food assistance in addition to Other Options.3. How satisfied are you with the selection of food items you have been receiving from Other Options Pantry since COVID-19 pandemic? *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Please explain why: 4. How often do you pickup food from the Pantry? *Weekly (Monday or Saturday pick up)Bi-weeklyMonthlyAs Needed5. If you could receive MORE of a type of food, which would you prefer? Check your top three. *Canned Vegetables / FruitsMeal Kits / Box DinnerCondiments/SpicesCereal (Hot or Cold)ProduceDairy / Cheese / ButterFresh/Frozen MeatsBreads / Fresh Baked goodsSnack Items6. If you could receive LESS of a type of food, which would you prefer? Check your top three. *Canned Vegetables / FruitsMeal Kits / Box DinnerCondiments/SpicesCereal (Hot or Cold)ProduceDairy / Cheese / ButterFresh/Frozen MeatsBreads / Fresh Baked goodsSnack Items7. Are there food items that you or your household need that you do not currently receive from Other Options Food Pantry? *NoYes I (we) really need: Please explain what food you/we really need: 8. If you or someone in your household receives SNAP/Food Stamp benefits, are there food items that your SNAP/Food Stamp benefits do not cover that you wish Other Options could supply? *We do not receive SNAP/Food Stamp benefitsNo, I (we) do not need anything additionalYes, I (we) really needSuggest some items you/we really need:9. How has COVID-19 impacted you or your household when accessing the Other Options Food Pantry? (Check all that apply)I, (we) are sheltering in place and still able to shop regularly.I, (we) are no longer able to shop at the regular pantry hours.I, (we) need masks for Adult(s)I, (we) need masks for ChildrenI, (we) need help with transportation and/or free testing options for COVID-19 so we can return to work.Mine / Our employment has changed.Mine / Our health insurance coverage has changed. We need help accessing medications.10. Please explain how COVID-19 related issues have impacted your life:MessageSubmit Share this:TwitterFacebookLike this:Like Loading...