MARC CLIENT INTAKE FORM - NATIONAL FAMILY CAREGIVER SUPPORT - marc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Client Information section. Enter your last name, first name, middle initial, gender, date of birth, and social security number. Ensure all fields are completed accurately.
3. Provide your address details including city and zip code. Select your county and marital status from the options provided.
4. In the Eligibility section, indicate if you are a Family Caregiver over or under 60 years old and specify your relationship to the care recipient.
5. Complete the Primary Emergency Contact and Second Emergency Contact sections with accurate information about each contact person.
6. Fill out the Referral Information section by checking any relevant services that apply to you or the care recipient.
7. Assess your Nutritional Status by answering the questions honestly and calculating your total score for risk level.
8. Finally, review all entries for accuracy before signing and dating the form at the bottom.

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