Enroll In Food As Medicine

Please fill out form below.

We Deliver.

Enrollment in this produce delivery service does not show as a public charge and will not affect any government aid, status, or current services you are receiving.

Food As Medicine Enrollment

Do you have a Referral ID?

If you have a nutrition related chronic condition (ex. diabetes, high blood pressure, etc.) and have not been referred by a health care provider, please reach out to one of our partnering clinics for a referral to the Recipe 4 Health program.

Alameda Health System- 664 Southland Mall, Hayward

Bay Area Community Health - 39500 Liberty St, Fremont

Native American Health Center - 3050 International Blvd, Oakland

LifeLong Medical Care - 10700 MacArthur Blvd, Oakland

Referred patients are prescribed food and/or a 3 month health coaching (group and individual) program through Open Source Wellness. If you have any questions or need help with the enrollment form, our Farmacist can assist you with beginning food deliveries at this number: (510) 383-6873.

CSA bags are available to purchase directly through this site for both enrolled and unenrolled individuals.

Referral ID

Patient First Name

Patient Last Name

Phone/Mobile

Address Line 1

Address Line 2

City

State

Zip Code

Country

Gate Code

Which Clinic were you referred by?

Delivery or Pick up Preference

Delivery

Pick up

^* You are not required to be home for deliveries, we will leave the produce.

Pick Up

Tuesday noon to 3 PM

Wednesday noon to 3 PM

Thursday noon to 3 PM

Not sure but will stop by

Delivery Notes

Are there any special delivery instructions needed for your place of residence? If no, leave blank.

Dietary Issues

Select all that apply

# Children in Household (0-17)

# Adults in Household (18-26)

# Adults in Household (27-59)

# Adults in Household (60+)

Do you or a family member qualify for public assistance?

Select all that apply

Race/ethnicity of all household members

You can select multiple

Does your household fall into any of these categories?

You can select multiple

Household Income

Dig Deep Farms is working with researchers from Stanford University to conduct surveys with Food Farmacy participants. Patients will be surveyed twice – before the first delivery and at week 12 of the program. Patients who complete both baseline and follow-up surveys may receive a total of $50 (paid via e-gift card). Do we have your permission to share your contact information with Stanford researchers?

Enroll In Food As Medicine

We Deliver.

Location