Application For Services | Meals on Wheels Wake County

Our goal at Meals on Wheels of Wake County is to nourish and enrich our clients’ lives through the services we provide. Our Home-Delivered Meals program helps our clients maintain a healthy lifestyle and remain living independently by providing nutritious meals, a weekly safety check, and friendly interaction. Please complete the form below to apply for services.

For those interested in dining at Friendship Cafe, please contact the Site Manager at your preferred Friendship Cafe location.

How is eligibility determined?

To be eligible for our services, you must be:

60 years of age or older
Living in Wake County
Additional factors contributing to eligibility may include:
Being homebound or needing help leaving your home
Unable to prepare meals or shop for yourself
Recent hospital stay or ongoing health problems
Primarily living alone or with a caregiver

If you live outside of Wake County, please click HERE to search for your local Meals on Wheels programs.

If you have an immediate need for assistance, please call 211 or Resources for Seniors at (919) 872-7933.

How do I refer myself or a prospective client to Meals on Wheels?

You, a family member or caregiver, must fill out the application below. If you cannot fill out the application online, please call 919-833-1749 Monday through Friday between 9:30 to 11:30 am.

How long will it take for my application to process?

Typically the application process takes 5 to 7 days. Several factors, such as where you live in Wake County, the current waiting list, and the availability of routes and volunteers, need to be taken into account on a case by case basis.

PROGRAM TYPE

Which program type are you interested in? Check all that apply.

Self Pay - $4.75 per meal and route availability

Waiting List, No charge for meals, must meet qualifications and route availability

Hospital to Home, Must be age 60 and over, referred by a Medical Provider, exclusively for individuals recently released from a hospital or rehabilitation center. (Meals provided for 10 days)

CLIENT INFORMATION

First Name

Last Name

Address (Street)

Apartment Number and Apartment Name

City

State

Zip Code

Client Telephone Number

Client Secondary Telephone Number

Client Email Address

Last 4 digits of SSN

Client birthdate

Gender

Race

Homeowner

Yes

Pronouns

He/Him

She/Her

Other

Primary Language

Language

MARITAL STATUS

What is your current marital status?

Are you a veteran or spouse of a veteran?

Yes

Spouse of veteran

List other agencies that are serving the client

REFERRAL INFORMATION

Referred By

Referral Agency

Telephone Number

Client Relationship

EMERGENCY CONTACT INFO

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Primary Telephone Number

Emergency Contact Primary Email Address

Secondary Emergency Contact Name

Secondary Emergency Contact Relationship

Secondary Emergency Contact Primary Telephone Number

Secondary Emergency Contact Primary Email Address

FRIENDSHIP CAFES

Can you drive to a Friendship Cafe site to eat meals Monday through Friday?

Yes

Do you have someone who can drive you to a Friendship Cafe site?

Yes

Is your daily life significantly affected due to memory loss or a cognitive impairment?

Yes

Has a doctor/healthcare professional diagnosed you with Alzheimer's disease or a related dimentia?

Yes

List mental and physical disabilities

NUTRITIONAL HEALTH SCREENING

Do you have an illness or condition that made you change the kind or amount of food you eat?

How many meals do you eat per day?

How many servings daily of fruit ?

How many servings daily of vegetables?

How many servings of milk and dairy products?

How many alcoholic beverages do you have daily?

Do you have tooth or mouth problems that make it hard for you to eat?

Do you always have enough money or food stamps to buy the food you need?

How many meals do you eat alone daily?

How many prescribed drugs?

How many over the counter drugs?

Have you lost 10 pounds in the past six months without trying?

Have you gained 10 pounds in the past six months without trying?

Within the past 12 months, did you worry that your food would run out before you received more money to buy more?

Yes

Within the past 12 months, did the food you bought just not last and you didn't have money to get more?

Yes

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