Meals on Wheels Inquiry Form

Submitting the information will not automatically add the individual to the Meals on Wheels program. Once you submit your web inquiry below, a phone call is not necessary — a Meals on Wheels OC or city representative will be in touch.

We provide Meals on Wheels in the following cities:

Anaheim
Brea
Buena Park
Costa Mesa
Cypress
Fountain Valley

Fullerton
Garden Grove
Huntington Beach
La Habra
Midway

Seal Beach
Orange
Santa Ana
Stanton
Tustin
Westminster

For Irvine, click here. For South County (Newport Beach and south), click here.

Information for Inquiry
Please provide the name, age, and contact information for the person in need of meals.
Name*
First Last
Age*
Please enter a number from 0 to 150.
Email address:
Phone Number*
Street Address*
City (must be in service region)*
Zip Code*
Preferred Language*
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Are you the person in need of meals?*
- Yes
- No
What is your relationship to the person in need?*
- I am a friend, family member, or caregiver
- I am from a company or agency
Friend, Family, Caregiver Information
Name*
First Last
Phone*
Email
What is your relationship to person in need of meals?*
Agency Information
Agency Name*
Name
First Last
Phone*
Email
Who contacted you regarding the person in need of meals?*
- The person in need contacted me
- A friend, family member, or caregiver contacted me
Friend or Family Information
Name*
First Last
Phone
Email
What is their relationship to the applicant?*
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How many days’ worth of meals does the person in need currently have?*
- None. Meals are needed immediately
- Just 2 to 4 days of meals
- At least 5+ days of meals
Comments:
Email
This field is for validation purposes and should be left unchanged.

Meals on Wheels Inquiry Form

Information for Inquiry

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Friend, Family, Caregiver Information

Agency Information

Friend or Family Information

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