Pettigrew Regional Library Hombound Service

Pettigrew Regional Library
201 E. Third Street
PO Box 906
Plymouth, NC 27962
252.793.2875

Shepard-Pruden Memorial Library - Chowan

Request for Homebound Service

Directions for completing the form online:
Enter your information in the fields below then click the Submit button. This information will be sent to us as an email. The information collected in this form is for our internal use only and will not be shared.

Name:
Physical Address:
City:
State:		Zip:
Phone #:

Please explain the circumstances which prevent your visiting the library in town:
	my own poor health or disability prevents my leaving my house
	responsibility for another family member with poor health or disability requires my constant presence at home
	there is no driver in the household
	other (please explain):

Please tell us of any services which you regularly receive at your house:
	Meals on Wheels
	visits from the Home Health Nurse
	other:

Thank you for sharing this information with us. If you have any questions, please call your County Library, or call Pettigrew Regional Library headquarters at 793-2875. When we receive your form, we will call you to discuss options for delivering library materials to your home on a regular basis.