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Thank you for contacting Humble & Kind for support. Please provide answers to the following questions so we can best support you and your family. (This form should be completed by the person in need of assistance.)

Contact Information

Demographic Information


Household Information

Do you have a health care provider?
Do you have medical insurance or medicaid?
Does your child(ren) have a health care provider?

Household Needs

Do you have transportation to Bellevue for any appointments?
Do you need baby items?
Do you need children's clothing?
Do you need hygiene items?
Do you need Emergency Meals?

*Disclaimer: In order to provide you with the best support, we may share your information with a health insurance provider.*


Thank you for reaching out to us for assistance. We look forward to meeting you soon.

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