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Client Details
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Agency - Pace
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Pace program
If your plan is part of the PACE program, please provide Support Coordinator approval confirming the availability of funding in CORE supports under either 01_020_0120_1_1 – Assistance with Household Duties, or 01_023_0120_1_1 – Assistance with the Cost of Preparation and Delivery of Meals.
Which service is this referral for?
Full Cook Service - Minimum 25 serves
Mini Cook Service - Minimum 15 serves
COOK EAT REPEAT cooking program
Pantry Purge
Off Menu Cooking Service - Not available in all locations.
Do you have a preferred day for the program?
Do you have a preferred time for the program?
Can you tell us a little about the participants disability?
Further Information or special requirements
Allergies, cultural food preferences, dietary compliance, etc.
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