Application Form

To apply, you can fill out this online application form or call our office directly at 613-233-2424.

Eligibility:

Individuals, who by receiving nutritional support, are better able to maintain independence and well-being in their own homes, including:

  • Seniors (60 +)

  • Adults who are chronically ill

  • Adults living with a physical or mental disability

  • Adults convalescing from surgery or illness

  • Adults undergoing medical treatment

Contact Information

Client Information

Client phone numbers (no special characters or dashes):

Client address:

Which program is of interest?
Preferred language:
Do you live alone?

Client Medical Information

Do we have your permission to share your personal health information with other agencies involved in the circle of care? *

Emergency Contacts

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

Emergency Contact #1:

Enter phone number without special characters or dashes:

Emergency Contact #2:

Enter phone number without special characters or dashes:

Additional Information

How did you hear about Meals on Wheels?
Do you have a Gift Certificate?