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AM/PM Option
This form will be available on May 14th @ 8:00 AM.
God bless & thank you!
Appointment Request: May 15th
Please fill out the form entirely. You will receive a text message Tuesday (14th) evening telling you what time to arrive at the crisis center on Wednesday, May 15th. Services are by appointment ONLY! Due to food supply limitations, if you do not have an appointment we will most likely have to turn you away. The best way to guarantee you will be served is to schedule an appointment. You may only visit us 1 time in a 1 month timeframe. If your are under that timeframe, your appointment will be cancelled and you will be informed of the cancellation via text. At this time we must limit the number of appointments to 20. We are located at 737 Byrd Ridge Road in North Wilkesboro, NC. NOTE: If you receive a thank you response after you submit, please show up for your appointment. Just in case you do not receive the appointment text or email.
Full Name:
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email Address
example@example.com
How many adults in the home? (Age 18+)
*
How many children in the home?
Children's ages:
Are you a new client?
*
Yes
No
When did you last visit the crisis center?
Can be a guess, does not have to be specific.
Please check any & all that you have access to at home:
*
Power
Water
Stove
Fridge
Microwave
Any food allergies?
Any food items you do not prefer?
Submit
Should be Empty: