1. Have your medical provider fill out this referral and medical form
Medical form MUST be filled and signed to complete your application.
https://www.glwd.org/get-meals/for-you-or-your-loved-ones-acq/client-forms-to-start-meal-delivery-acq/
Application Client Forms to Start Meal Delivery
Thank you for your interest in receiving medically tailored meals from God’s Love We Deliver! This webpage provides forms to be completed for new clients to start our home-delivered meal program.
Please know that in order to qualify for program, you or your loved one must:
- live with a chronic or life-altering illness like cancer, Alzheimer’s, renal failure, COPD, HIV/AIDS, or other serious condition
- must live in NYC or Hudson County, NJ
- and must have difficulty grocery shopping and cooking.
We deliver delicious meals right to your door whether you’re living with or recovering from an illness, and having trouble shopping or cooking.
Please note that applications without a signed medical form are incomplete.
Electronic Application forms (can be submitted in any order)
After submitting your forms electronically:
Once your medical provider and you complete the signs above, the Client Services team will review your forms for eligibility. You will receive a phone call or email *if we have received the forms and you qualify.*
Después de enviar sus formularios electrónicamente:
Una vez que su proveedor médico y usted completen todos los formularios, el equipo de Servicios al cliente revisará su aplicación para determinar si reúne los requisitos. Recibirá una llamada telefónica o un correo electrónico *si hemos recibido los formularios y si califica.*
Prefer to Download and Mail Forms? Use the Below!
If you prefer to complete the application process by downloading our forms, please do so by downloading, printing and returning our Application Packet here.
Si prefiere completar el proceso de solicitud descargando nuestros formularios, hágalo descargando, imprimiendo y devolviendo nuestro paquete de solicitud aquí.
You will need to get a medical provider’s signature on page 4 and then please return by:
Fax: 212.294.8198
Email: gethealthymeals@glwd.org
Mail:
God’s Love We Deliver
c/o Client Services Department
166 Avenue of the Americas
New York, NY 10013.
