1. Have your medical provider fill out this referral and medical form
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 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.
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.*
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.
You will need to get a medical provider’s signature and then please return by:
Fax: 212.294.8198
Email: clientservices@glwd.org
Mail:
God’s Love We Deliver
c/o Client Services Department
166 Avenue of the Americas
New York, NY 10013.
Clients living with HIV, or their referrers, should complete the above forms, AND submit the following documents:
- Proof of Income and Residence: click here to access the form
- Grievance Form: click here to access the form
When filling out the form, please be sure to click “submit” to ensure your information is saved and sent to us. FormDr, the online tool for completing these forms, is HIPAA compliant.
