Welcome to EmpathyKare Home-Delivered Meals

EmpathyKare offers convenient home-delivered meal selections designed to provide clients with choices while supporting their individual preferences and documented dietary needs.


Clients may select from our available breakfast, lunch, dinner, side, vegetable, bread, fruit, and dessert options.


Special requests are welcome. If EmpathyKare can accommodate your request, you will be notified. Menu selections are subject to change based on availability, supplies, client demand, and the continued growth of our Home-Delivered Meals program.


Thank you for choosing EmpathyKare!

New Client Enrollment

New Client Enrollment Form

Home-Delivered Meals Service Consent

Home-Delivered Meals Service Consent Form

IMPORTANT — PLEASE READ

CLIENT/REPRESENTATIVE MUST NOTIFY EMPATHYKARE IMMEDIATELY OF ANY NEW OR CHANGED FOOD ALLERGY, PRESCRIBED DIET, SWALLOWING OR TEXTURE RESTRICTION, OR OTHER DIETARY REQUIREMENT.

By signing below, I acknowledge and agree that:

  1. I consent to receive Home-Delivered Meals services from EmpathyKare Home Care in accordance with my authorized service plan.
  2. I will provide complete and accurate information about food allergies, dietary restrictions, physician-ordered diets, swallowing/texture needs, dislikes, and meal preferences.
  3. I understand special requests are welcome but are not guaranteed. EmpathyKare will notify me when a request can be accommodated.
  4. I understand menu selections are subject to change based on food availability, client demand, supply limitations, and the continued growth of the meal program.
  5. I understand meal selections are due by Tuesday at 4:00 PM for planned Sunday delivery. Delivery dates or times may change because of weather, emergencies, or other unfavorable conditions, and I will be notified when possible.
  6. I agree to safely receive, refrigerate or freeze, store, and reheat meals according to provided instructions. I will not consume food that appears spoiled, damaged, improperly stored, or unsafe.
  7. I will notify EmpathyKare as soon as possible if I will not be available for a scheduled delivery or if my delivery instructions change.

Electronic Signature / Acknowledgment

By typing my name below, I intend it to serve as my electronic signature and acknowledge that I have read, understand, and agree to the statements above.

Allergy, Diet & Preference Information

Allergy, Diet & Preference Information Form

Acknowledgment

I confirm that the allergy and diet information above is accurate to the best of my knowledge. Special requests are not guaranteed; EmpathyKare will notify me when a request can be accommodated.

Privacy Practices

Notice of Privacy Practices

Privacy Practices Form

NOTICE OF PRIVACY PRACTICES

I acknowledge that I received or was given access to EmpathyKare Home Care's Notice of Privacy Practices, which explains how protected health information may be used or disclosed and describes my privacy rights.

Authorization to Release/Exchange Information

Authorization to Release/Exchange Information Form

Purpose: Coordination and safe provision of Home-Delivered Meals services

I understand that I may revoke this authorization in writing at any time, except to the extent action has already been taken in reliance on it. I understand that signing is voluntary and that services generally may not be conditioned on signing an authorization except as permitted by law. Information disclosed under this authorization may be subject to redisclosure by the recipient and may no longer be protected by HIPAA.

Client Rights & Responsibilities

Download Here

Client Rights & Responsibilities Form

Your Rights

  • Receive services respectfully and without discrimination
  • Receive information about meal service, ordering, delivery, menu availability, and changes.
  • Have your privacy and personal information handled according to applicable privacy requirements.
  • Have documented food allergies, preferences, gluten sensitivity, prescribed diet, and swallowing/texture needs considered within the authorized service and program capabilities.
  • Make a complaint or raise a concern without retaliation.
  • Request reasonable clarification about your meal service records and whom to contact with concerns.

Your Responsibilities

  • Provide accurate and current food allergy, reaction, diet, gluten sensitivity, swallowing/texture, and preference information.
  • Notify EmpathyKare immediately of any new or changed food allergy, prescribed diet, swallowing/texture restriction, or other dietary requirement.
  • Submit weekly meal selections by the stated deadline and report changes with the weekly order.
  • Provide accurate delivery/contact information and notify EmpathyKare when you will not be available for delivery.
  • Follow meal storage, expiration, preparation, and reheating instructions and do not consume food that appears unsafe.
  • Understand that menu items and delivery schedules may change because of availability, demand, program growth, weather, emergencies, or other unfavorable conditions.

Acknowledgment

I acknowledge that I received and reviewed these Home-Delivered Meals Client Rights & Responsibilities and had an opportunity to ask questions.

Weekly Meal Ordering

SELECT MY MEALS

Weekly Meal Ordering Form

Select Your Weekly Meals (2 Meals Daily / 14 Meals per Week)

Special requests are welcome. If EmpathyKare can accommodate your request, you will be notified.

IMPORTANT — REQUIRED WITH EVERY MEAL SELECTION

THE CLIENT/REPRESENTATIVE IS RESPONSIBLE FOR NOTIFYING EMPATHYKARE IMMEDIATELY OF ANY NEW OR CHANGED FOOD ALLERGY, PRESCRIBED DIET, SWALLOWING/TEXTURE RESTRICTION, OR OTHER DIETARY REQUIREMENT.

By typing my name below and submitting this weekly meal order, I intend my typed name to serve as my electronic signature. I confirm that I reviewed my meal selections, read and understand the dietary acknowledgment above, and provided accurate information to the best of my knowledge.

ORDER DEADLINE

WEEKLY MEAL SELECTIONS MUST BE SUBMITTED BY TUESDAY AT 4:00 PM FOR SUNDAY DELIVERY.

Delivery schedules may change due to weather, emergencies, or other unfavorable circumstances. Clients will be notified of changes when applicable.

MENU AVAILABILITY

Menu selections are subject to change based on food availability, supplies, client demand, and the continued growth of the EmpathyKare Home-Delivered Meals program. Items may be added, substituted, temporarily unavailable, or discontinued.


Limited-time selections will be identified when available.