Prospective Clients

stock-photo-close-up-of-senior-adult-woman-laughing-on-phone-220380241 Thank you for your interest in Meals on Wheels of Columbia! We look forward to serving you. Use this page as a resource as you consider signing up for our program. We will be in contact with you shortly.

Name:

Address:

Phone:

Email:

Type of living:
HouseApartmentTrailerCondo

Birthdate:

Veteran:
YesNo

Start Date:

Race:
CaucasianBlackAsianOther

Gender:
MaleFemale

Who referred you to MOW?

Reason for Service:
Chronic illness or DisabilityAge (65+)Recent HospitalizationOther

Emergency Contact Name:

Emergency Contact Phone:

Relationship:
SonDaughterRelativeFriendPOAOther

Physical Status:
Vision-OKHearing-OKMobility-OK

Diet:
RegADA2grSodiumRenal

Bread:
WhiteWheatNone

Mike Pref:
1%SkimWholeJuice

Food Dislikes:

Food Allergies:

Difficulty Chewing or Swallowing
YesNo

Our Client Says

"I am able to eat and learned how to eat portions. It has kept me off insulin shots as I lost over 80 lbs over time."

Company Profile

Meals on Wheels of Columbia is a non-profit organization that aims to extend independence to seniors in our community. Through the help of our many volunteer drivers, we are able to provide a hot, nutritious meal to those with limited mobility.Read More

Email Updates

Enter your email below to receive periodic email updates from Meals on Wheels of Columbia

Name*
First Last
Email*