Client Application Form

Client Information


Medical Information

Emergency Contacts

I give consent to Meals on Wheels to call the following emergency contacts:

Previous KnowledgeFamily/friend/volunteerAging in place coordinatorWebsiteHospitalOther:

If other, please specify


Did you know?

During the 2019-2020 fiscal year we delivered 96,017 meals (including 10,597 meals through the Going Home and Aging in
Place programs) to 1514 clients with the help of 366 volunteers.