Meals on Wheels

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Meals on Wheels

Sign up here to receive Meals on Wheels - hot meals and warm hellos for people in the Greater Lyons area who are not able to shop for or prepare at least one nutritious meal each day.

If you have questions or concerns, please email our program leader, Pam Browning, at mow@leaflyons.org. Alternatively, you can call or text her at 720-310-8479.

Email *

Your name, first and last *

Are you completing this form for yourself or for someone else? *

Myself

Someone else

Name of person who will receive meals *

What is the client's birth date? *

YYYY

What is the client's living situation? *

Lives alone

With spouse or partner

Other:

Please provide the full delivery address *

Please provide the billing address (unless Project Homecoming) *

Email address *

Phone number *

When should meal delivery begin? *

As soon as possible

A future date

I need to speak with someone about it

Other:

On which days should we deliver meals? *

Monday (this is "Sandwich Monday," with meals generously donated by St. Vrain Market)

Tuesday

Wednesday

Thursday

Friday

Frozen meals for weekends

Project Homecoming

Required

Is this a Project Homecoming request? (We will provide 5 free meals to anyone who is released to come home from any hospital, regardless of the reason for hospitalization.) *

Yes

If a Project Homecoming request, from which hospital will the client be discharged, and on what date? *

Are there any special dietary requests? *

Are there pets in the home? If so, what kind? *

Please briefly describe why the client needs meals and any unique considerations for our volunteer drivers. *

Does the client drive? If so, please provide color and make of car. (We ask this question to help our volunteer drivers confirm our clients' well-being. As an example, if the client does not come to the door as usual and the car is in the driveway, our driver will make efforts to ensure our client is safe and well.) *

What is the client's monthly income? (The cost of meals is based on the client's monthly income. We use a generous sliding scale, and nobody is turned away for inability to pay. Our team leader will follow up to confirm meal cost.) *

Less than $800 per month (typical cost is $1.00 per meal)

$801 - $1100 (typical cost is $1.50 per meal)

$1101 - $1400 (typical cost is $3.00 per meal)

$1401 - $1700 (typical cost is $3.50 per meal)

Over $1701 (typical cost is $4.00 per meal)

Not applicable - Project Homecoming

Who will be responsible for the monthly invoice? Please provide name, address, phone number, and email. (Not applicable if Project Homecoming.) *

Please provide contact information for 3 of client's emergency contacts. Please include name, relationship to client, phone number(s) email address, and let us know if the contact holds a key to client's home.

Emergency Contact #1 *

Emergency Contact #2

Emergency Contact #3

THANK YOU. We look forward to delivering hot meals and warm "hellos" and hope you will enjoy and appreciate our service. If you have questions or concerns, please email our program leader, Pam Browning, at mow@leaflyons.org. Alternatively, you can call or text her at 720-310-8479.

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