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Aeroflow Connect SDoH Program

Our program aims to bridge gaps in healthcare access by connecting individuals and families to essential social services. Through a comprehensive digital and verbal enrollment process, the program helps patients access vital resources like health insurance, nutrition services, housing, behavioral health, and transportation assistance.

Complete the form below to see how we can help you today!

Aeroflow Connect SDoH Program

I am the(Required)
Name(Required)

Please select the answers that apply to you or the patient. All questions are optional.

Help us support your health and improve care for all patients by filling out this form. We will do our best to connect you with resources but may not be able to provide direct assistance. Your answers are confidential. We may use general information that does not identify you from these answers for hospital reporting. Thank you!
What is your living situation today?
Do you need support with housing?
(emergency shelter, eviction prevention, rent help, housing application)
Do you need support with fixing problems in the place you live?
(pests, water leaks, mold, lead paint, home too cold or hot, stove/oven not working)
Within the past 12 months, you worried whether your food would run out before you got money to buy more.
Within the past 12 months, the food you bought just didn’t last and you didn’t have money to get more.
Do you need support with food?
(apply for SNAP, WIC, referral to food pantry)
Do you need food for tonight?

Do you need support with:

Getting transportation for medical appointments
Paying for utilities
(heat, electricity, internet, or phone bill)
Paying for medicines
Taking care of a child, elder, or disabled person
Doing day-to-day activities, such as bathing, preparing meals, or shopping, due to illness or disability
Looking for a job, changing jobs, or getting job training
Getting more education or help with school
(early child education under 5 years old, high school diploma or GED, college level education)
Accessing resources to address immigration needs
Managing or growing your money
(open a bank account, file taxes, save money, improve credit, buy a house)
Using a computer or phone to manage your health
(use MyChart, see medical records, make appointments, get refills, message care team)
For any question you checked “Yes,” can we refer you to free or low-cost programs?