Ollie's Plate Intake

Overview

Ollie’s Plate is Ollie Hinkle Heart Foundation’s (OHHF) “Food is Love” initiative to provide heart individuals and families with nutritious meal bundles. We empower families to incorporate healing with nutrient-dense foods into their wellness plans. These services are currently available for individuals and heart families who access care at one of our Missouri hospitals. 


Please take a few minutes to answer the following questions to help us better understand how to support you through this program.


Note that submission of this application does not guarantee fulfillment of the request. Please be assured that all your information is kept confidential per our privacy policy. OHHF values your privacy and does not share or sell your information to third parties without your written consent. We use the information you provide to improve our services and better understand your needs and the needs of the heart community.

Name & Contact Information






















Tell us about your heart condition













The OHHF team will contact you to discuss discharge information and timing.

If yes, please submit here.

Tell us about your Heart Warrior

























The OHHF team will contact you to discuss discharge information and timing.

If yes, please submit here

Tell us about your health coverage & your household









If so, please complete the form here. Requests will be evaluated on a case-by-case basis and subject to available funding.

Please complete the application here.

Tell us if you are facing any of these barriers

Please answer the following questions as honestly as possible.









Tell us about your financial health

The information provided on this page will help us determine the number of meals OHHF can provide through Ollie’s Plate. Please answer the following questions honestly by selecting the statement that best represents your needs. 


Our team will reach out after we review your intake form to talk about options.


Definitions:
* Basic needs include food, housing, and transportation.
** Expendable income might mean you can regularly buy coffee at a shop, buy new clothes, go to the movies, etc.











Meal Planning Needs


























A member of the OHHF team will review your submission and requests and work with our meal vendor to select your meals based on your preferences and how many meals we are able to provide. We will contact you with any questions.

References

Please provide two references. These can include your social worker, nurse, physician, or other healthcare provider.










Consent to Participate in Ollie's Plate

By typing your name below, you are acknowledging and agreeing to the following regarding your request:

  • I have reviewed OHHF’s website privacy policy and agree with all terms.

  • I have reviewed OHHF’s client rights and responsibility policy and agree with all terms.

  • I understand that OHHF has not and will not provide me with medical, legal, or tax advice.

  • I will complete a client satisfaction survey if approved for discharge meal services.





I hereby authorize the name/s listed below to discuss and participate in coordinating my services through the Community Outreach Program. I understand that if a name is not listed below, Ollie Hinkle Heart Foundation cannot release any information.