Who should fill out  a Registration Form?

Have you ever attended any Openhouse activities, support groups, or informational seminars?   Have you sought assistance from Openhouse to find housing? Has Openhouse provided you with a referral to a healthcare or social service provider? Are you involved in the Openhouse Friendly Visitor Program? If you can answer YES to ANY of these questions, we invite you to fill out a registration form.

What is a “Registration Form”?

A registration form includes information about you that Openhouse, as a community-based service provider, needs to know in order to meet your specific needs. An registration form generally includes basic information such as your name and contact information as well as emergency contact information, demographic, and health-related information.  Registration forms are very important because they help Openhouse tailor our programs to meet the needs of LGBT older adults and people with disabilities. Funding from the San Francisco Department of Aging and Adult Services is also based on the number of registration forms we complete. The more completed registration forms we have, the better able we are to show that LGBT seniors need the services and activities we offer. This information helps Openhouse secure critical public funding for our programs!

What does Openhouse do with my information?

The Registration Form All service providers funded by the San Francisco Human Services Agency (including Openhouse) are required to complete this registration form for recipients of their City-funded services. This registration form authorizes Openhouse to share your identifiable health information with the San Francisco Human Services Agency and other approved service providers for the limited purpose of referring you to services that best fit your needs, tracking which services are being utilized and preventing the duplication of services across a multitude of providers.

NOTE:  Please note that the information collected the registration form is confidential and kept in secured, locked files at Openhouse.  Openhouse strictly abides by the standards set by the Heath Insurance Portability and Accountability Act (HIPAA). Openhouse will only provide your information to the San Francisco Human Services Agency upon your written approval and will not share your information with any other third parties without your written permission.

Please note that you are NOT required to complete the registration form in order to receive services or participate in Openhouse activities. We request that you complete the form in order to help us serve you better and demonstrate that Openhouse is effectively meeting an identified community need.

Completing this form is very helpful for both Openhouse and the San Francisco Human Service Agency to demonstrate the needs of LGBT older adults, secure funding, refer you to services that best fit your needs, measure service utilization and reduce duplication of services. However, if you are uncomfortable with sharing your information with the San Francisco Human Services Agency, you may complete the Openhouse Registration form, which is still extremely helpful.

The process is simple and takes about 15 minutes.  If you haven’t completed a registration form for Openhouse in the last two years, please fill out and submit the form below.  Please give us a call at 415-296-8995 if you have any questions or need help completing the form. We can help you over the phone or set up an in-person appointment.  It’s easy, and a great opportunity to let us know what you need and what kind of programs you’d like us to provide.

NOTE:  Please note that if you have completed an intake within the past two years, you do not need to fill one out again. If you don’t know whether or not you’ve completed a form, give us a call.

How do I submit my Registration?

I’m SO glad you asked!  First, you will need to ensure you have Adobe Acrobat Reader installed on your computer.

Don’t worry, it’s free!

If you already know you have Adobe Acrobat Reader installed, please feel free to download the registration form by clicking on the link provided below.

Once you have completed this form, please print it and either mail it in a secure envelope or delivery in person to: Openhouse, 65 Laguna Street St, San Francisco, CA 94102; or fax it to 415-296-8008.  Please don’t forget to sign the last page.

Openhouse Registration form click here!
DON’T FORGET TO SIGN THE LAST PAGE

Click here for Adobe Acrobat Reader installation instructions
as well as instructions on viewing/saving the above files.

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