FV Registration Please enable JavaScript in your browser to complete this form.1Welcome!2Client Details3Additional Questions4Referral Information5PreviewThank you for showing interest in MOWL’s Social Programs! Meals on Wheels London provides free social programs to any of our clients who may be experiencing social isolation or loneliness. We offer one-on-one social calls, group calls and outings, Seniors Centre Without Walls, Tuesday/Thursday wellness check ins, a Buddy System, and other types of support. NextClient DetailsSocial Programs You Are Interested In *One on One Social CallsGroup Phone Programs (Seniors Centre Without Walls)The Buddy System (MOWL clients paired together for regular social conversations)Lunch Bunch (Group visits to MOWL for a social lunch)Wellness Check Ins (Tuesdays & Thursdays)Meals on Wheels London offers a variety of social programs. Please see descriptions below and select what you are interested in. One on One Social Calls: Wellness Check Ins (Tuesdays & Thursdays): Seniors Centre Without Walls Lunch Bunch Buddy System Social StoriesClient DetailsClient's Name *FirstLastClient's Phone Number *Client's Date of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Client's AddressAddress Line 1CityState / Province / RegionPostal CodeClient's EmailTell Us A Little Bit About YourselfNextAdditional QuestionsDoes the Client Have Any Food Allergies? *Does the Client Have Any Dietary Restrictions? *DiabeticGentleGluten FreeHalalLactose FreeNo Added SaltVegetarianVeganNo Dietary Restrictions (REGULAR)Does the Client Have Any Texture Requirements? (E.g. Minced or Pureed) *MincedPureedNo Texture Modifications (REGULAR)PreviousNextWho is Filling Out this Form?Name of Person Completing This Form *FirstLastPhone Number of Person Completing This Form *Email of Person Completing This FormHow Did You Find Out About Our Program? *PreviousNextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit
