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Client Application Form Meals-on-Wheels of White Plains Service
This form is only for residents of the City of White Plains, unable to shop or cook for themselves because of their medical condition (ex.- illness or injury) or advanced age to apply to receive Meals-on-Wheels for themselves or for a member of their family. If you are a family member completing the form for another person, please complete Section D, including the nature of your relationship (ex.- child, sibling, etc.) and be sure to provide our contact information. Thank your for considering the use of Meals-on-Wheels of White Plains service.
If you are from a referral agency – please scroll down the page to download your form. It is different.
Referral Form for Agency (ex.-Social Worker, etc.) to Use
If you are from an agency (ex. – Social Worker, Discharge Planner, Physical Therapist, Doctor, etc.) looking to make a referral to Meals-on-Wheels of White Plains please click this link: Referral Form for Agency Use to download the form.
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