Service Enrollment Form

Getting home-delivered meals is simple. Requests for home-delivered meals may be made by a recipient, a family member, physician, friend, social worker, or another community organization. To enroll, call our office or submit the form below.

That’s all there is to it. Once an application is processed, our Services Coordinator will contact you to arrange for delivery of meals, usually within 24-48 hours after a dietary prescription has been returned to our office from your physician. This form is for Indiana residents only.