Meals on Wheels Application Form

Please complete the following information about the meal recipient.

Please tell us about the meal recipients nutritional needs, physical condition and reliance on others. This information will help our Client Services team assess the individual for specific care needs.

Please list those we can discuss the recipient's well being with or contact for emergency purposes.

Please list the recipients primary care physician contact information.

Feed More’s Meals on Wheels has a Meals for Pets Program! Pet food, when available, is delivered once a month during regular meal delivery for a recipient. All pet food is donated and free of charge.

Feed More’s Meals on Wheels service fee is either $6 or $11, based on the level of service associated with meal delivery. A limited number of sponsorship opportunities are available through Senior Connections, Jefferson Area Board for Aging (JABA), Crater District Area Agency on Aging and directly through Feed More. Applicants may request a reduced or waived service fee and will be required to provide additional information to support their request. No one will be turned away based on income.