Client Application

 
1 Start 2 Start 3 Complete, select Submit

Once we have received your completed enrollment form, we will be in touch

to confirm your start date.  If you have not heard from our office within 48 hours, please call 970-484-6325.

CLIENTS UNDER THE AGE OF 62 MUST HAVE A MEDICAL CONDITION PREVENTING THE ABILITY TO PREPARE MEALS AND BE HOMEBOUND. MEDICAL VERIFICATION MUST BE INCLUDED WITH YOUR APPLICATION. Email your verification to info@fcmow.org.

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If you would like to be considered for a reduced fee, we require documentation of your gross monthly Income (such as a bank statement, direct deposit info, social security statement, etc, ). Please include a copy with your application. Email your verification to info@fcmow.org.

What type of meal do you want?
You may choose up to 3 meals per delivery
Do you have pets?
PLEASE CHECK THAT YOU HAVE READ AND UNDERSTAND THE FOLLOWING
Meals on Wheels utilizes volunteer drivers to deliver your meal and are not trained in home health care so are unable to assist in any medically -based tasks including dressing, moving clients, etc.
I UNDERSTAND THAT BY TYPING OR SIGNING BELOW, I ACKNOWLEDGE AND CONFIRM THAT ALL OF THE INFORMATION I HAVE PROVIDED IN THE ENROLLMENT FORM IS TRUE AND COMPLETE
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