Referral Form

We serve people of ALL ages and ALL incomes who are homebound and unable to prepare their own meals. We serve people with temporary needs (following surgery, severe illness, during chemotherapy, etc.) and long-term needs, too. Need more details? Visit our Meal Delivery, Feeding Friends, or Nutritional Drink pages first!

Are you a medical professional referring a patient? Please complete our Medical Referral Form to initiate meal delivery!

Ready to get a meal for a friend, family member, neighbor, or even yourself? Please complete this form ONLY for individuals living in the following zip codes: 29464294662949229451, and 29482. If the potential recipient does not reside in one of those zip codes, please call Trident United Way’s Hotline by dialing 2-1-1 to find a meal delivery program that delivers to their area.