❄️ Frozen Meals on Wheels - Service Request Form

1📃 Contact Information

2🐔 Chicken

3🐄 Beef

4🐖 Pork

5🍝 Pasta

6⭐ Featured

7🥣 Soups

8📝 Review Order

To order from our frozen meals menu please complete the form below. Frozen meals are delivered on Wednesdays. The cost per meal is $8.60 including taxes and delivery. Minimum of 6 meals per delivery order.

Are you a current client?(Required)

Please note that new clients are required to undergo an intake interview to determine their eligibility, as well as to review the role and responsibilities of the client and the agency providing the service. This must be completed before service begins.

Delivery or Pickup Options

Your Contact Information

Name(Required)

First Last

Telephone Number(Required)

Referrer Information

Referrer Name(Required)

First Last

Relationship to Client

e. g. son / daughter or name of referring organization

Referrer Telephone Number(Required)

Referrer Email

Client Information

Client Name(Required)

First Last

Client Telephone(Required)

Client Email

Select your meals by choosing the quantity each of the meals you would like in each meal category.

🐔 MEALS (CHICKEN)

Select the quantity of each meal you would like.

BAR-B-Q Chicken

Price:

Slow roasted chicken with BBQ sauce, onions, celery, mushrooms, and carrots. Served with rice pilaf.

Quantity

Butter Chicken

Price:

Fresh tender chicken breast stewed with sweet potato, paprika, pepper, garlic, ginger, zucchini, mushrooms and onions, cinnamon and cilantro.

Quantity

Chicken Alfredo

Price:

Tender roasted chicken breast sauteed in our own rich alfredo sauce. Served with seashell pasta.

Quantity

Chicken Creole

Price:

Fresh tender chicken breast stewed in chili spiced tomato sauce, carrot, celery, onions and green peppers. Served with rice pilaf.

Quantity

Chicken Pot Pie

Price:

Fresh chicken breast, onions, celery, and carrots stewed with diced potato in chicken gravy, topped off with a home baked pie crust.

Quantity

Chicken Stew

Price:

Fresh chicken breast, onions, basil, and oregano, stewed with diced potato, celery, mushrooms and carrots.

Quantity

Chicken Teriyaki

Price:

Julienned teriyaki chicken thighs served on a bed of rice with carrots, broccoli, onions and zucchini.

Quantity

Harvest Chicken

Price:

Chicken breast with fresh zucchini, mushrooms, onions and rice pillaf. Served in a tomato cream sauce.

Quantity

Lemon Dill Chicken

Price:

Fresh diced chicken breast, garlic, onions, basil, oregano, dill, and lemon juice, stewed with diced tomatoes, celery, mushrooms, carrots and rice.

Quantity

Mushroom Chicken

Price:

Grilled Bar-B-Q chicken, juicy steamed mushrooms, tomato sauce, zucchini, onions, and carrots. Served with rice pilaf.

Quantity

Pineapple Chicken

Price:

Tender chicken breast marinated in our very own pineapple sauce. Served with diced pineapple, green peppers, onions and rice.

Quantity

Souvlaki Chicken

Price:

Lemon garlic herb marinated chicken breast. Served on a bed of rice with green pepper, onion and tomato.

Quantity

Subtotal

🐄 MEALS (BEEF)

Select the quantity of each meal you would like.

Beef Stew

Price:

Tender cubes of steak seared and then simmered in our tasty gravy with potato, carrots, celery, onions and herbs.

Quantity

Cabbage Rolls

Price:

Beef with rice wrapped in cabbage leaves stewed in tomato sauce with zucchini, mushrooms and carrots with rice.

Quantity

Hearty Chilli

Price:

Savory ground beef stewed in diced tomato sauce with kidney beans and select herbs and spices.

Quantity

Honey Garlic Meatballs

Price:

Meatballs tossed in a honey-garlic glaze, mixed with zucchini, mushrooms and onions. Served with rice.

Quantity

Liver and Onions

Price:

Roasted baby beef liver with fried onions and gravy served with mashed potatoes, turnips, carrots and green peas.

Quantity

Meatloaf

Price:

Homemade and baked to perfection served with carrots and mashed potato.

Quantity

Roast Beef Dinner

Price:

Tender slow-cooked roast beef smothered in our own delicious gravy. Served with green beans and roast potatoes.

Quantity

Shepherds Pie

Price:

Seasoned ground beef with a layer of creamed corn and corn niblets, topped with our own mashed potatoes.

Quantity

Steak and Mushroom Pie

Price:

Slow cooked steak, onions, celery and carrots stewed with diced potato in gravy topped with baked pie crust.

Quantity

Swiss Steak

Price:

Onion, turnips, carrots, tomatoes and peppers fried with our own marinated steak in red wine gravy. Served with roast potatoes.

Quantity

Subtotal

❄️ Frozen Meals on Wheels - Service Request Form

Your Contact Information

Referrer Information

Client Information

Select your meals by choosing the quantity each of the meals you would like in each meal category.

🐔 MEALS (CHICKEN)

🐄 MEALS (BEEF)

Select the quantity of each meal you would like.

🐖 MEALS (PORK)

Select the quantity of each meal you would like.

🍝 MEALS (PASTA)

Select the quantity of each meal you would like.

⭐ MEALS (FEATURED MEALS)

Select the quantity of each meal you would like.

🥣 SOUPS

Select the quantity of each soup you would like.