The Breathing Association
Helping you breath easier

About Us

Programs

Make a Donation

Advocacy

Air Quality

Employment

Volunteering

Partners

Helpful Links

Location

Contact Us

Home

 

Overview Winter Crisis Program Summer Crisis Program Outreach Application FAQ
Precentage of Income Payment Plan (P.I.P.P)
Program Partners Customer Service Survey

 


Outreach

TBA has expanded its outreach services to include Health Clinics as well as home visits for the medically homebound. If you or someone you know is in need of a home visit and they meet the criteria, an Outreach Case Manager will come to their home to assist them in receiving HEAP services. Call 457-2997 to speak to a representative of our HEAP outreach department or complete and e-mail the Home Visit Request Form

HEAP Record of Home Visit.

Untitled Document

Today's Date
Client Name:
Client Address:
City:
Zip Code:

Reason for Home Visit (Type of Infirmity)



What are the special circumstances requiring the home visit?:



Household Size: Adults   Children

Household Income:  3 Month   12 Month

Main Streets:
Office Use Only:
Date the Home Visit was completed:

Signature of HEAP Case Manager: