FARE Registration

First Name*

Last Name*

Email*

Mobile Phone

State*

State

Shipping Address*

Street Address City State ZIP Code

Your Login

Create a strong password. If you don't have an email address you'll be able to login with your mobile phone.

Password*

Enter Password Verify Password

Strength indicator

Minimum of 10 characters long and contain at least one uppercase and one lowercase letter (A,z), one numeric character (0-9), and one special character (such as !, %, @, or #)

Enter your 10-digit Invite Code:*

You can find your invite code in your welcome email.
Include hyphens when entering the code.

Date of Birth*

Gender*

What is your race?*

Select all that apply

American Indian or Alaska Native

Asian Indian

Black

Chinese

Filipino

Guamanian or Chamorro

Hispanic

Japanese

Korean

Native Hawaiian

Other Asian

Samoan

Other Pacific Islander

Vietnamese

White

Other

Other Race*

Are you of Hispanic, Latino, or of Spanish origin?*

Do you have any food allergies or intolerances?*

Select all that apply

Egg

Fish

Milk / Dairy

Peanut

Sesame

Shellfish (e.g., shrimp, crab, lobster)

Soy

Tree Nut (e.g., almonds, cashew, hazelnut)

Wheat

Other

No food allergies or intolerances

Other Allergy or Intolerance*

Do you have any existing health conditions?

Select all that apply

None

Hypertension (high blood pressure)

Eczema

Cancer

Crohn’s Disease

Celiac Disease

Diabetes - Type 1

Diabetes - Type 2

Gastrointestinal Disease

Heart Disease

Kidney Disease

Sickle Cell Disease

Asthma

Thyroid Disorders

Behavioral Health

Anemia

Other

Other Health Condition

Do any of the following dietary preferences or restrictions apply to you based on your religion or cultural background?*

Check all that apply

None

Vegetarian

Vegan

Halal

Kosher

Gluten-free

Lactose intolerant

Other

If you have any dietary preferences or restrictions that are not mentioned above, please share them with us:

How would you describe your current nutrition knowledge?*

Very low

Low

Moderate

High

Very High

Tell us about your household

The following questions ask about your household. For these questions, your household includes you and anyone else who lives with you in your place of residence (e.g. home, apartment). This includes your spouse, any other family members, or roommates.

How many Adults currently live in your household?*

Adults 18+ years

How many Children currently live in your household?*

Children 0-17 years

What language do you speak at home?*

Select all that apply

English

Spanish

Other

Other Language

Over the past 12 months, how many times did you utilize an emergency food provider (e.g., a food pantry)?*

Never

1-5 times

6-10 times

11 or more times

Within the past 12 months we worried whether our food would run out before we got money to buy more.*

True

False

Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.*

True

False

How do you prefer to receive updates and information from us?*

SMS/Text Messages

Phone Calls

Social Media

Website/App Notifications

Postal Mail

The following questions ask about you and your experience with your healthcare provider and general health.

Have you seen your doctor in the last 12 months?*

Yes

Are you physically active (exercise, walking, etc) 3 times a week or more to improve your health?

Consent*

I agree to receive SMS text notifications

By submitting this form, you agree to receive SMS updates on your order status and reminders from Attane Health. Msg&data rates may apply. You can opt-out at any time by replying "STOP". For assistance, reply "HELP". Your information will be handled in accordance with our Privacy Policy.

Getting Started

Your Login

Tell us about your household