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.


    Main Address

    Mailing Address (if different)
    Street Address

    Emergency Contact:

    Race (please select)


    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:
    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
    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.

    Support our Mission
    Connect with Us
    Contact Us
    4323 Boulder Highway
    Las Vegas, NV 89121
    501(c)(3) nonprofit agency
    EIN Tax ID #86-0845241
    Hours of Operation

    Pantry – Walk ins are welcome during our pantry hours (9:00-1:00pm Monday through Thursday). Please make sure to bring ID, Social, and proof of income and address. At your first visit to the pantry you can schedule an appointment every two weeks. To schedule your pantry pick up email pantryreservation@lssnv.org or call 702-639-1730

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

    For more information, please call or e-mail info@lssnv.org.