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Food Order Form

Food Order Request Form

Please use the form below to request your prescription food item. This will save you time when picking up your order. Please allow 24 hours for order processing. Do not come to the clinic until you have received confirmation to pick up your order. A staff member will contact you by phone or email once the item is ready to be picked up.

IMPORTANT: Food orders are placed on Wednesdays at noon. All orders must be received before noon on Wednesdays, otherwise they will be placed on the next week's order list.