FoodRx Self Referral Form

Our FoodRx program is now open to self-referrals! If you would like to be a part of the program but don’t have a physician referral, look no further.

Fill out this form and tell us a little bit about yourself to get signed up!


To qualify for the program you must:

  • Be a Walton County resident
  • Be aged 64 or younger
  • Have a diagnosis of overweight status, obese, prediabetes, diabetes, or high blood pressure
  • Have, or are at-risk for, other chronic lifestyle related disease

Financial Assistance

The program comes with a minimal charge, but those who have financial burdens or food insecurity could qualify for our free program.