TO QUALIFY – Meals on Wheels

Homebound- not leaving the home more than two to three times weekly
Physically and/or Mentally incapable to prepare meals
Live alone, is home alone during the day, or with someone else who has similar difficulties

If you are over the age of 60 and meet the listed qualifications please complete the questions below. For anyone under the age of 60 and have these same challenges please have your physician complete the link below.

For questions about this process feel free to call our office at (864) 225-6800.

Date(Required)

Does the client live in Anderson County?(Required)

Yes

Sorry, we are unable to service clients outside of Anderson County.

Is client over the age over 60 and Homebound?(Required)

Yes

Please have your physician complete the remainder of form.

Clients Name(Required)

First Last

Clients Name(Required)

First Last

Clients Phone Number(Required)

Clients Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Clients Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Clients Date of Birth(Required)

Clients reason for needing home delivered meals:(Required)

Referred By:

Referred By(Required)

Friends Name(Required)

First Last

Friends Name(Required)

First Last

Friends Phone(Required)

Physicians Name(Required)

First Last

Physicians Name(Required)

First Last

Name of Practice(Required)

Physicians Phone(Required)