• Meals For The Elderly Recipient Application

  • In order to help us process your application as quickly as possible, please ensure that all information is included before you submit. If you have any questions, please call Client Services at 325-655-9200 Ext. 111.

    An incomplete application can cause a delay in the approval process.

  • What hours is the home health provider in the home? (Please put a time next to the days)

  • Emergency Contacts:

    Can be neighbor, relative, or friend (At Least 2, must be different from next of kin)

  • Should be Empty: