DigiMart Senior Registration Form

    Welcome to Lutheran Social Services of Nevada!

    If you are a senior (60+) seeking services, please complete the intake form below. All answers will be kept confidential by LSSN staff members.




    Gender:




    Main Address






    Mailing Address (if different)
    Street Address






    Emergency Contact:







    Race (please select)


    Ethnicity



    If you do not speak English, what is your primary language?



    Your Income is:

    And is also:



    Do you:
    Live Alone?
    Have a Disability?
    Consider Yourself Frail?

    Are you:
    Unable to leave your home without assistance?
    A veteran/served in the armed forces?
    On state Medicaid?
    A caregiver?
    If yes, for whom do you provide care?



    Activities of Daily Living (ADLs)
    Without assistance, I am unable to:
    Bathe
    Eat
    Walk
    Get Dressed
    Use the Bathroom
    Transfer In or Out of a Bed or Chair
    None - I can perform these activities


    Instrumental Activities of Daily Living (IADLs)
    Without assistance, I am unable to:
    Prepare Meals
    Take Medication
    Manage Money
    Shop
    Do Light Housework
    Do Heavy Housework
    Use the Telephone
    Use Transportation Services
    None - I can perform these activities



    Thank you for completing Lutheran Social Services of Nevada's intake form! A staff member will be reaching out to you soon to complete the intake process and to provide you with your unique user number, which will enable you to order food online.

    For any questions, e-mail Nutrition Services Manager Jocelyn Gonzalez-Rodulfo at jrodulfo@lssnv.org.



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    4323 Boulder Highway
    Las Vegas, NV 89121
    501(c)(3) nonprofit agency
    EIN Tax ID #86-0845241
    702-639-1730
    Hours of Operation

    DigiMart – Beginning 4/30/2020, DigiMart is open on Tuesdays and Thursdays between 8:00 a.m. and 11:00 a.m.

    Open Air Markets – Beginning 3/7/2020, all Open Air Markets have been temporarily postponed due to COVID-19.

    For an up-to-date schedule on the special Open Air Markets, check out our Facebook page at facebook.com/lssnv.

    As of 3/19/2020, all other services are available by appointment only. For more information, please call or e-mail info@lssnv.org.