Service Request

*** Exceptional Hearts Inc. is currently serving Douglas County, Georgia residents who are over the age of 60 and those who are unhoused at this time with the anticipation of expanding to the surrounding counties by the summer of 2026. If you are not in Douglas County, we will gladly connect you with resources in your area.***

Last name

Phone

Address

Members in Household

Anyone in the home with a physical, intellectual, or developmental disability? (autism, wheelchair bound...)

Ages of all household members.

What are you in need of? (List is subject to change depending on availability of resources)

Food

Toiletries

Are you over the age of 60? (Proof of age will be required)

Yes

Are you experiencing homelessness? This can include not having a place to sleep, living in a shelter, car or on the streets, and/or couch surfing.

Yes

Douglas County, GA Resident Acknowledgement

By checking this box, I acknowledge that I am a resident of Douglas County, GA.

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