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.

Go To FormContact Intake Team

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

Upload required PDFs and complete the form in one step. Everything is sent together to the Hayat admission API for intake review.

Client Information

Emergency Contact

Responsible Party / Best Contact

Program Schedule

Preferred Days

Medical Information

Equipment / Aids

Social History

Required Documents (PDF or image)

Upload the supporting documents listed in the Hayat admission packet. Each file can be PDF, JPG, or PNG (max 10MB). Required items are marked with *.

Policies & Electronic Signatures

Per the admission packet, the client or representative and the responsible party acknowledge Hayat policies and CDPHE requirements with an electronic signature.

Client / representative signature *

Sign with your finger (mobile) or mouse (desktop). This acts as your electronic signature on the employment contract and HR packet.

Responsible party signature (if applicable)

Sign with your finger (mobile) or mouse (desktop). This acts as your electronic signature on the employment contract and HR packet.

One submission sends your intake details and all uploaded documents to Hayat for review.