Marc intake 2026

1. Click ‘Get Form’ to open the marc intake in the editor.
2. Begin by entering your last name, first name, and middle initial in the designated fields. Ensure accuracy for proper identification.
3. Select your gender and enter your date of birth, Social Security Number (SSN), and Document Control Number (DCN) as required.
4. Fill in your address, city, phone number, and zip code. Choose your county from the provided options.
5. Indicate whether you live alone by selecting 'Y' for Yes or 'N' for No.
6. Provide details for your primary emergency contact, including their name, relationship to you, and contact numbers. Confirm if they are aware of their role as an emergency contact.
7. Complete the marital status section by selecting the appropriate option that describes your current situation.
8. Fill out eligibility criteria based on ethnicity and income sources. Mark all applicable boxes.
9. Assess your nutritional status by answering the questions provided. Tally your score based on 'Yes' responses to determine risk level.
10. Finally, sign the form as a client and include the date before submitting it through our platform for processing.

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