Welcome to our Meal Sign-Up page. This application will take approximately 5-7 minutes to complete.

    NOTE:
    *After submission, a client services representative will call you to discuss the program and finalize your application. Please know there may be a registration fee associated with your application. All clients are required to be on automatic payments in order to receive service (Clients who qualify for free services may be exempt). Calls are made in the order in which applications are received.

    Face-to-face meal delivery is available ONLY for clients residing in the Albuquerque, Rio Rancho, and Corrales areas. Clients who reside outside of these areas can still receive frozen meals through overnight delivery, though they may incur additional shipping and handling charges.


    YesNo




    YouThe Client



    MaleFemaleGender nonbinary/Genderqueer/Gender nonconformingTransgenderDecline to State







    HomeCell




    YesNoDecline to state





    YesNo


    Asian American/AsianBlack/African American/AfricanHispanic/Latino/Latina/LatinxMiddle EasternNative American/American Indian/IndigenousPacific IslanderWhite/CaucasianMulti-racial/Multi-ethnicDecline to StateIdentity not listed here


    YesNo



    YesNo


    VeteranNot a VeteranSpouse of a VeteranDon't Know or N/A





    RegularHeart HealthyDiabeticRenalVegetarianPre-CutMechanically SoftenedPureed


    EggsNutsCitrusCoconutChileDark GreensFishPork


    012345


    012345


    012345


    012345


    012345


    MilkNo Milk


    01234567


    Not ApplicableMondayTuesdayWednesdayThursdayFriday


    Add breakfastAdd dinner


    YesNo


    YesNo


    YesNo


    Do you understand that you or another person MUST be home to receive delivery between the hours of 10:00am - 2:00pm. Meals on Wheels will not leave a meal unattended at your door. Failure to be home without prior notification may result in additional fees and/or removal from the program.
    Yes, I understand


    Do you understand that Meals on Wheels may call a Wellness Check with APD on your behalf if if we are unable to reach you or your emergency contact for a missed delivery?
    Yes, I understand


    Do you understand that Meals on Wheels New Mexico has limited options available for menu exclusion requests and that no guarantee can be made that meals will be completely free of allergens. Additionally, exclusion of certain foods from your menu may result in receiving multiples of the same side dish or vegetable per day/week and/or may result in receiving an “alternate” main dish (chicken or beef patty) instead of the planned main entrée for the day.
    Yes, I understand






    YesNo










    YesNo


    01 time2-3 times4 or more times


    01 time2-3 times4 or more times


    NoYes


    NeverRarelySometimesOften