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Home-Delivered Meal Program Referral Form

Eligible applicants must be age 60 or over, homebound, unable to drive or utilize public transportation, unable to leave their home independently, unable to shop and/or prepare a nutritious meal, and not be attending a day-time program (e.g., dining program, adult day care program, etc.).*

*An individual under the age of 60 may be eligible with an approved waiver (DHS, PACE, NHPRI, Rhody Health, etc.)

Step 1 of 3 - Person Making the Referral

  • Person Making Referral

  • Client Information

  • MM slash DD slash YYYY