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Choose all services that apply

Meals on Wheels
Seniors Morning Out

Person making the referral

Relation

Self
Family Member
Friend
Health Care Professional

Your Phone Number

Phone Type

Home
Cell
Work

Your email address

Person needing services

First Name

Last Name

Street Address

City

Zip

Phone Number

Additional Phone Number

Date of Birth

Physician's Name

Choose all that apply

Homebound
60 years of age or older
Unable to cook
Unable to shop

To be eligible for Meals on Wheels, you must be homebound (unable to get out and go, even if transportation is provided), 60 years of age or older, and a Catawba County resident.

Alternate Contact

Such as a relative, friend, or neighbor.

Alternate Contact First Name

Alternate Contact Last Name

Alternate Contact Phone Number

Phone Type

Home
Cell
Work

Relation