Heali-BGWp

Self-Screening Tool

Welcome.

Please take about 10 minutes to answer these questions.

Your answers help us see if and how we can help you. You may get help with things like food or housing support.

If you can, have your Medicaid number ready before you start.

Your answers are private. They will not change your benefits.

After you finish, we will look at your answers. If you need help, a HEALI team member may call you. They can help connect you to programs near you.

Want to talk to someone now?

Email or call 516-505-4434. Our team members can help you in your language.

Need help with this form or want ASL? Our staff who know ASL can help.

Video Phone (VP): (347) 309-4171

Answering these questions takes 10 minutes.

If you’re short on time, we can follow up. Leave your phone number or email, and a HEALI team member will reach out to help you finish the screening and connect you to services.

By sharing this information, you consent that HEALI may contact you for screening. Your information will be kept private and used only for this purpose.