Apply to Receive Meals

This form is for people looking to receive meals. Fill it out and some one will contact you within two business days. Check out our events page, these events help us provide affordable meals.

Meals on Wheels provides a hot meal delivered around noontime M-F (10am to 12pm)

The meal includes a meat, starch, 2 vegetables, drink (juice or 2% milk), bread, dessert and soup or salad depending on the day. You can visit our menu page to see a weekly updated menu. We also deliver donations of bread and other items as donated to us.

Application for Meals:

We only service Polk County Florida.

Meal Recipient Information:*

How did you hear about Meals on Wheels Polk:*


English
Spanish
Other
Alone
Caregiver
With Family
With Spouse
Other

Single
Married
Divorce
Widow
Dog
Cat
Other
None

Emergency Contact Information:*

No Emergency Contact?

If you do not have an Emergency(We like everyone to have at least one emergency contact. This can be a friend or neighbor)

Information for Person Requesting Meal Service for Someone Else (if different from above)*

I am filling out form for myself
I am the Emergency Contact
Other