Service Enrollment – Meals on Wheels Hamilton County

Service Enrollment

Enrollment Now

Getting home-delivered meals is simple and easy. 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 recipient application at the bottom of this page.

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. This form is for Indiana residents only.

Recipient First Name*

Recipient Last Name*

Recipient Address*

Recipient Address Line 2

City*

State*

Zip*

Recipient Phone Number*

Date Of Birth (Format: ##/##/#####)*

Primary Physician Name*

Physician Phone Number*

Ethnicity*

Living Arrangements*

Monthly Income*

Primary Emergency Contact Name*

Secondary Emergency Contact Name

Primary Emergency Contact Phone Number*

Secondary Emergency Contact Phone Number

Preferred Start Date

Meal Options*

Beverage Options*

Food Allergies

Name Of Person Completing Form*

Phone Of Person Completing Form*

Billing Options*

Email Address*

Message*

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The mission of Meals on Wheels of Hamilton County, Indiana supports individuals who are elderly, disabled, chronically ill and home-bound by delivering nutritious meals, reducing hunger, improving health and promoting independence.

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395 Westfield Road
Noblesville, IN 46060-1425

Call us at (317) 776-7159

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