Thank you for your interest in Meals on Wheels of Fredericton!

Please complete the following form to request Meals on Wheels service. This information helps us get to know you and understand your needs so we can provide the best possible service.

Note: You can complete this form for yourself or on behalf of someone else. If you are helping, please ensure the person receiving meals (or their decision-maker) is aware.

Your information

(person requesting meals)

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Delivery information

What days would you like meals delivered? (please select all that apply):(required)

Dietary requirements

Contact information

If we have questions about your application, meals, or delivery, who should we contact?(required)

If you selected family or other support person above, please provide their contact information below:

Support Person #1 (optional)

What is this person’s relationship to you (person receiving meals)?

Support Person #2 (optional)

What is this person’s relationship to you (person receiving meals)?

Billing information

Who should the bill for Meals on Wheels be sent to?(required)

If “Someone else” was selected above, please provide their information below:

Additional comments