Application for Service | Meals on Wheels of Summerville

Preliminary Questions

Do you live in the Greater Summerville or Ladson area, South Carolina?

Yes

Do you have a current medical condition which limits your ability to prepare meals?

Yes

You may not qualify for our services if you are not located within the Greater Summerville or Ladson area.

Please contact TAAA (Trident Area Agency on Aging) for further assistance.

You may not qualify for our services if you do not have a current medical condition which limits your ability to prepare meals.

Please contact United Way 211 for further assistance.

Contact Information

Prefix

First Name

Last Name

Date of Birth

Home Phone Number

Cell Phone Number

Delivery Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Subdivision Name

Service Request made by

Self

Family/Friend

Medical Practice

Other…

Referral Information

Referrer First Name

Referrer Last Name

Referrer Phone

Referrer Email

Referrer Relationship to Client