Services on Demand Pre-Registration

Services on Demand Pre-Registration

Bringing essential on-site services to Shelby County residents
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Mobile Number
Phone Number
Do you live in Shelby County?

YesNo

Food Assistance

Food bags are limited
How many people are in your household?

Transportation Services

Provided by Treetop Transportation
Services Needed

Doctor's AppointmentDialysis ClinicHospital DischargesSenior Center
More information will be given on day of event.

Medication Assistance

provided by
For individuals of any age who are disabled, have applied for disability, or their doctor deems them disabled can qualify for help through SenioRx.
Medications you are needing assistance with:

Medicare Counseling

provided by
Individuals interested in Free Medicare Counseling must bring their Medicare cards and list of medications on the day of event.
Should be Empty: