Online Meal Request

Meals on Wheels are nutritious meals that are delivered Monday – Thursday between 10:00 AM – 2:00 PM.

We serve seniors who live in Multnomah or Washington counties in Oregon & Clark County in Washington
The cost of each meal is $9.05. Participants are asked to contribute to the cost of the meal
Participants must be at home to receive meals
Meals on Wheels volunteers have received background checks and training prior to delivery
Please request meals when you are ready to receive them

How to Request Meals on Wheels Service:

Complete the form below. Meals on Wheels People staff will call you to review your eligibility in the program. To discuss your eligibility, please call 503.953.8111 or toll-free 866.788.6325

NOTE: To request a call to discuss the home-delivered meals program, please fill out the form below and we will contact you as soon as possible.

*required field

Your First Name:

Your Last Name:

Your Phone Number:

Your Email:

Your Relationship to Client/Recipient:

First Name:

Middle Initial:

Last Name:

Date of Birth

Address:

Apt/Unit Number:

Apartment Complex (if applicable):

Phone:

Alternate Phone:

City:

State:

Zip:

Primary Language (if other than English):

Does the participant know meals are being requested?
yesno

Does the participant have a Medicaid / COPES case manager?
yesno

Name of Case Manager:

Phone Number of Case Manager:

Emergency Contact First Name:

Emergency Contact Last Name:

Emergency Contact Phone:

Relationship to Participant:

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