Client Registration Form


Instructions for Case Workers Concerning Meals on Wheels Referrals


  • Evaluate beneficiaries. 
  • Register beneficiaries by filling out the form below.  It is important to provide all relevant information; this document is an essential tool which could well allow us to react effectively to any eventuality.

For the beneficiary's own safety as well as that of Meals on Wheels volunteers, it is important for us to be made aware of certain factors regarding the physical and mental health of the person referred (depression, alcohol abuse, major cognitive impairment, unsanitary living conditions, behavioural problems, etc.).  It goes without saying that any such information you provide to us will remain confidential.

This service is intended for:

Anyone who is unable to prepare adequate meals for one or more of the following reasons:

          • Loss of autonomy, whether temporary or due to aging

          • Temporary or permanent physical disability

          • Mental health or intellectual impairment problems

          • Cognitive impairment

          • Nutritional problems or lack of motivation to feed oneself properly


Registration procedure:



If you are unsure whether Meals on Wheels delivers in the beneficiary’s area, contact the liaison officer at the Central Office of Volunteer Food Services to make sure. 




If the request is for two people living at the same address (a couple, two sisters, etc.):

Please fill out 1 form per person.


N.B.:  If the person is not sure they want to receive Meals on Wheels, leave them your contact information so that they can confirm their interest BEFORE you register them.






Fill out the beneficiary registration form below:

Once finished, click the "Submit" button to make sure we receive your form!

If you have the paper form, please answer ALL questions legibly, using large block letters and fax it to 514.842.8977.


Thank you!


Indicate ONLY the door number of the address in this field.

Indicate ONLY the name of the street in the above field.

Indicate the area code

Other persons living at the same address

Contact person

Professional section


If you would like a copy of your answers for your files, please print this form BEFORE clicking "submit."

For further information, please contact the liaison-sab [at] cabm [dot] net (Liaison Officer), at 514.842.3351.