Apply to Receive Meal Service/Refer a Recipient

Please note that we serve the Greater Tampa area. If you live in East Hillsborough County please contact Meals On Wheels of Plant City (813) 754-9932, Meals On Wheels of Brandon, or Hillsborough County Aging ServicesPara espanol, clic aqui.

Thank you for inquiring about receiving home delivered meals from Meals On Wheels of Tampa. Freshly prepared, hot meals are delivered between 9:30AM-1PM, Monday through Friday, by volunteers. in addition to the hot meal, fresh frozen soup is provided on Thursdays and a bag of fresh produce on the 3rd Saturday of the month. Frozen weekend meals are available and are delivered on Fridays.

If you would like to apply to receive home delivered meal service, please fill out the form below. We will contact you within 1-5 business days. Thank you!

RECIPIENT APPLICATION
*Indicates required field

Recipient Information

Recipient First Name*:

Recipient Last Name*:

Recipient Home Address*:

Apartment Name and Gate Code:

City*:

State: FL

ZIP Code*:

Recipient Phone Number (Home):

Recipient Phone Number (Other):

Recipient E-mail:

How did you hear about Meals On Wheels of Tampa*?
ChurchDoctorFamily/FriendHome health providerHospitalInternet (website, google)Letter in the mailOtherPostcardSelfSocial Media (Facebook, Twitter, etc.)Social Worker/Case ManagerSomeone who receives mealsTV/News/PrintVolunteer

Recipient Birthday*:

Gender*:

Race*: Asian or Pacific IslanderBlack or African AmericanHispanic or LatinoNative American or American IndianOtherWhite

Are you a veteran*? YesNo

What is your primary language*?

Has a doctor ever told you that you have a chronic disease? If so, please indicate which one(s):
ArthritisCancerDiabetesHeartOtherStroke

Please describe your health*:

What are your living arrangements*?

How many people live in your household*?

What is your current marital status?

What is your monthly income*?

What are your monthly expenses*? (ie. rent, electric, prescriptions, food, etc.)

Do you have pets*? CatDogNo

If we were to be able to provide additional menu options, which would most appeal to you?*
Choice (i.e. no chicken, no beef, no pork, etc.)ChoppedDiabeticFrozenLatinPureedRegularRenalVegetarian

Emergency Contact Information

Emergency Contact Name:

Emergency contact Phone:

Emergency Contact Relationship:

I would like Meals On Wheels to contact:MePerson requesting meal service on my behalf (see their contact information below)

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

First Name:

Last Name:

Referring physician/group (if applicable):

Relationship to person needing meal service?

Phone Number:

Email: