Teledirect Meal Service

Thank you for signing up for Meals on Wheels. This process will take approximately 7-10 minutes to complete.

Before we begin, we will need some information to complete this application. We will need your GROSS monthly income to determine your meal cost. If you do not have this information, you will need to call us back.

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 though they may incur additional shipping and handling charges. Clients must live in New Mexico to receive services. Clients living outside New Mexico cannot receive services and should call their local senior center for assistance.

This application is for ONE client. Households who are interested in receiving meals for more than one person will need to complete an application for EACH member of the household who will be receiving meals.

Teledirect

Teledirect

Are you completing this application on behalf of someone else? If NO (you are the client), please skip to "Client Information" section below.
If you are not the client, please provide your name and phone number
If you are not the client, please provide your name and phone number
First
Last
Who should we contact to ask questions about this application?
CLIENT INFORMATION
Client Name (Required)
Client Name (Required)
First
Last
Client Gender Identity (Required; Check all that apply)
Client Address
Client Address
City
State/Province
Zip/Postal
Is this a home or cell phone?
Does the client identify as having a disability?
Will the client need an interpreter?
Client Race and Ethnicity
Does the client have any pets?
***PLEASE REMEMBER THAT PETS MUST BE PUT AWAY AT TIME OF DELIVERY.***
For clients who have a dog or cat: We have partnered with Long Leash on Life and other generous donors to offer clients complimentary dog or cat food, veterinary visits, dog walking, and more. This program is available for UP TO TWO dogs or cats PER HOUSEHOLD. Would you like to sign up to receive complimentary pet food and other pet wellness opportunities?
Client Veteran Status (Required)
Type of Diet Needed
Food Allergies (Although we try to accommodate all requests, we do not make guarantees)
Please select the amount of HOT LUNCH meals you would like delivered on:
Monday
Tuesday
Wednesday
Thursday
Friday
Would you like to receive milk with your hot lunch meals? (Your choice will not effect the cost of your meals)
Frozen meals are delivered in bulk, one day per week. Frozen meals may be selected to supplement hot meals OR in place of hot meals when a once per week delivery is more convenient. REMINDER: IF you have elected to receive 5 hot meals, any additional frozen meals will be charged at the full price. Please select the number of FROZEN LUNCH meals you would like to receive each week.
What day you would like to receive your FROZEN LUNCH meals?
In addition to the lunch meal we offer, we also offer a smaller, chilled or shelf stable breakfast and dinner (sandwich plus a side) Breakfast/Dinners are $3.70 each and are available with your hot lunch. Would you like to add breakfast and/or dinner to your hot lunch meals? If yes, please check below.
We have partnered with the ABQ Journal to offer all our clients a FREE copy of the Journal with their meal delivery. Would the client like to receive the ABQ Journal newspaper with their meal?
We have partnered with Roadrunner Food Bank and Silver Horizons to offer clients monthly bags of shelf stable foods. Weekend Pantry Bags may not be appropriate for all diet types. Would the client like to receive a monthly pantry bag?
Would you like to sign up to receive an emergency meal in case of winter weather closure? (Emergency meals will be delivered in Nov/Dec each year. There is no additional charge for this emergency meal)
Delivery Acknowledgement (Required): Do you understand that the client 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 removal from the program.
Wellness Check Acknowledgement (Required): 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?
EMERGENCY CONTACT INFORMATION
Emergency Contact Name (Required)
Emergency Contact Name (Required)
First
Last
Does the client live with the Emergency Contact? (Required)
MEAL PRICING DETAILS

Maximum file size: 314.57MB




pritingtiers


Client Pricing Tier
BILLING INFORMATION
Bill to Name (Required)
Bill to Name (Required)
First
Last
Bill to Address
Bill to Address
City
State/Province
Zip/Postal
Country
Help save paper! Use this email to send invoices.
CLIENT WELLBEING QUESTIONS. Please answer these questions to the best of your knowledge. Answers to these questions assist us on grant applications and other reports. All data is combined with other respondents and no personally identifiable information is used when reporting.
Other than a regular check-up or follow-up, how many times in the past three (3) months did you have to go to the doctor? (Example: visiting a doctor for an emergency or new illness)
In the past three (3) months, how often did you have to choose between paying a bill (rent, utilities, car, buying medicine, etc.) or buying food?
In the past three (3) months, have you fallen in your home?
In the past three (3) months, how often have you felt depressed or very sad?
ACKNOWLEDGEMENTS
Delivery Acknowledgement (Required) 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 removal from the program.
Wellness Check Acknowledgement (Required) Do you understand that Meals on Wheels may call a Wellness Check with the Albuquerque Police Department on your behalf if we are unable to reach you or your emergency contact for a missed delivery?
Allergy Acknowledgement (Required) 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.