Meals on Wheels Hold Request Form

Please make sure to tell us at least two business days before your next delivery to pause your meals.

If you need to cancel or hold your meals until further notice please call 804-673-5035.

Which of the below describes you best?

Your Name

First

Last

Your Phone Number

What is your relationship to the applicant?

Please tell us which agency you are part of

Recipients Name

First

Last

Recipient's Address

Address Line 1

Address Line 2

City

State

Zip Code

Recipient's Phone Number

Please select a reason for the hold

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

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