Direct Intake Link
Hayat Admission Form
This page gives clients and families a direct link to submit intake details online. The fields are based on your Hayat admission packet so your team can review the client, medical, schedule, and contact information before follow-up.
Direct link: /admission-form
Before You Submit
The packet also asks families to provide supporting documents before the first day of service and to schedule an intake meeting with the director or nurse.
- Client medical report signed by a licensed physician within the last 6 months
- Guardianship, conservatorship, or power of attorney documents if applicable
- Insurance cards and government-issued identification
- Immunization records or physician statement of contraindications
- Tuberculosis screening documentation from the last 12 months
- Advance directives, living will, or CPR/DNR orders if applicable
What This Form Covers
- Client information and address
- Emergency contact and responsible party details
- Preferred attendance days and transportation
- Medical, dietary, and mobility information
- Social history, interests, and family goals
This page is wired for the dedicated admission backend contract and can submit directly to the HayatCare API instead of the generic inquiry email flow.