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
* Required
Email address
*
Your email
Are you a new or existing customer?
*
I am a new customer
I am an existing customer
Name
*
Your answer
Birth date
MM
/
DD
/
YYYY
55 years or older?
*
Yes
No
What is your address?
Your answer
Phone Number
Your answer
Email address
Your answer
How many meals a week would you like?
*
Monday
Tuesday / Wednesday
Thursday / Friday
Required
Do you eat fish and/or Shellfish? Click all that apply.
*
Fish
Shellfish
Neither
Required
Do you have any Allergies?
*
Your answer
Any Dietary constraints?
Gluten Intollerant
Lactose intollerant
Low Sodium
Diabetic
Other:
Clear selection
Delivery Instructions (other than front door)
Choose size and number per color
Your answer
Preferred contact method
*
Phone
Email
Required
Questions and comments
Your answer
Submit
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