Referral Form - vnatexas.org

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Referral Form

 Below is the referral form that will need to be completed on each individual who wishes to receive meal service.  Please feel free to contact VNA Haggerty Center with any questions or concerns or help with the form at 214-689-2268.

Referral Source

Referral Options

The referral will be submitted for review by one of our funding sources. Meals on Wheels are funded by state agencies and also private community donations. Due to the high demand for Meals on Wheels, it can take up to 8 weeks for response either by phone or by mail.

The client can choose to purchase the amount of meals they would like to receive per week. Each meal is $5.50. With this option the client can begin service within 2 business days. Meals are billed on monthly basis; you will receive a bill each month. No eligibility required.

Bill To:

Third Party Address:

Client information

Eligibility Criteria

Viewport: