Meals On Wheels Registration / Schedule update

IMPORTANT INFO !
Meal deliveries take place Monday, Tuesday and Thursday, including 3 hot meals 2 cold meals a per week.
We do not offer weekend deliveries.
Please fill out one form for each individual client.


After you fill out this order request, we will contact you to go over details and availability before the order is completed.
If you would like help filling out this form please call 1-250-785-6328
Email address *
Are you a new or existing customer? *
Name *
Birth date
MM
/
DD
/
YYYY
55 years or older? *
What is your address?
Phone Number
Email address
How many meals a week would you like? *
Required
Do you eat fish and/or Shellfish? Click all that apply. *
Required
Do you have any Allergies? *
Any Dietary constraints?
Clear selection
Delivery Instructions (other than front door)
Choose size and number per color
Preferred contact method *
Required
Questions and comments
Submit
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