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Meals on Wheels

Meals on Wheels

Home Delivered Meals assure recipients at least one healthy, substantial meal delivered to their home. There are two options which include a choice between a hot meal delivered Monday through Friday at noontime or frozen meals delivered to your door in two- week increments.

Complete the application below to request Meals on Wheels meal delivery services.

Request Meals on Wheels Service

Complete the application to request Meals on Wheels meal delivery service.

Recipient Information

First name*

Last name*

Address*

Apt / Suite / Unit

Address Type*

City*

State*

Zip Code*

Phone*

Email

Race*

Date of Birth*

Gender*

Recipient is a U.S. military veteran.

Branch of Service

Annual Income*

What is the reason for requesting home-delivered meals?*

Does Recipient live alone?*

Yes

No

Is Recipient's family in the area?*

Yes

No

Is Recipient visually impaired?*

Yes

No

Is Recipient mobility impaired?*

Yes

No

Is Recipient chronically ill?*

Yes

No

Does Recipient have pets?*

Yes

No

Is Recipient able to use a stove or microwave oven?*

Yes

No

Is Recipient diabetic or require low-sugar desserts?*

Yes

No

Does Recipient require 2% milk?*

Yes

No

Requested Deliver Schedule

Monday and Friday

Monday, Wednesday, and Friday

Tuesday and Thursday

Emergency Contact

Emergency Contact Name*

Emergency Contact Phone*

Emergency Contact Relationship*

Billing Information

Billing information is the same as the recipient information.

Billing First Name

Billing Last Name

Billing Address

Billing Address 2

Billing City

Billing State

Billing Zip Code

Billing Phone

Billing Email

Elder Services of Okaloosa County Florida Care Lift

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Community Care for the Elderly

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Elder Services of Okaloosa County is the designated Lead Agency for the Community Care for the Elderly (CCE) Program in Okaloosa County. The CCE program was created by the Florida Legislature to assist functionally impaired elderly persons to live dignified and reasonably independent lives in their own homes, or in the homes of relatives or caregivers.

Elder Services also contracts for the Federal Older Americans Act (OAA) which assists with in-home services to help clients remain in the preferred setting of their home. The CCE program compliments the Older Americans Act to ensure the most supportive array of services.

(850) 833-9165

Elder Services of Okaloosa County
207 Hospital Drive N.E.
Fort Walton Beach, FL 32548

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