Fill out the following form to place your order. Specify the quantity to be delivered in the box to the left of each item. Click the Place Your Order button when finished.

Your Name: Date meal is to be delivered:
Your Email Address: Time meal is to be delivered:
Your Phone Number: Patient's Name:
    Patient's Room Number:

Breakfast
Breakfast Entrees
Hard Boiled Eggs
Scrambled Eggs
Scrambled Eggs Substitute * Cheese Omelet *
Ham and Cheese Omelet
Vegetarian Omelet *
French Toast * Buttermilk Pancakes *
Belgium Waffles
Sausage
Hash Browns Bacon
Ham
   
Cereals *
Oatmeal
Raisin Bran
Cream of Wheat  
Rice Krispies
Cornflakes
Frosted Flakes  
Cheerios
Shredded Wheat
Bran Flakes  
Fruit *
Apple
Orange
Banana Peach Halves
Applesauce
Seasonal Fruit Cup
Pear Halves  

Bake Shop
Plain Bagel * Cinnamon Raisin Bagel * English Muffin * Blueberry Muffin
Bran Muffin Fresh Baked Cinnamon Roll Donut  
Bread *
White Wheat Rye  

Clear Liquid Diet
Broths *
Vegetable Beef Chicken  
Beverages
Juices: *
Apple Peach Cranberry Lemonade
Soda:
Lemon-Lime Cola Diet Cola Caffeine-free Diet Cola *
Fruit Punch * Vernors Diet Vernors  
Other:
Coffee Decaf Coffee * Hot Tea Decaf Hot Tea *
Iced Tea      
Finishing Touches *
Popsicles Fruit Ice Gelatin Sugar-free Gelatin

Full Liquid Diet
Cream of Wheat * Cream of Chicken Tomato Soup *  
Juice *
Orange Cranberry Apple Prune
Fruit Punch Peach    
Milk
Skim * 2% Whole Chocolate
Lactose Free * Hot Chocolate Sugar-free Hot Chocolate  
Pudding *
Chocolate, regular Vanilla, regular Vanilla, sugar-free  
Ice Cream
Chocolate Vanilla    

From the Grill
Hot Dog Cheeseburger Hamburger * Gardenburger *
Fried Fish Grilled Chicken * Chicken Fingers Grilled Cheese
Grilled Ham & Cheese      
Extras
Lettuce * Tomato * Onion * Pickle
Baked Potato Chips * Potato Chips Pretzels  

Main Course
Roast Pork w/ Gravy * Baked Cod * Roast Turkey w/ Gravy * Macaroni and Cheese
Marinated Chicken Breast * Homestyle Meatloaf with Gravy Fajitas, beef Fajitas, chicken *
Spaghetti w/ Marinara Spaghetti w/ Meat Sauce Fresh Baked Pizza, cheese Fresh Baked Pizza, pepperoni
Fresh Baked Pizza, vegetarian Fresh Baked Pizza, ham Stir-Fry over Rice, chicken * Stir-Fry over Rice, Vegetable *

On the Side
Whipped Potatoes * Steamed Rice * Baked Potato * French Fries
Bread Dressing Macaroni and Cheese Sliced Carrots * Green Beans *
California Blend * Corn * Broccoli * Gravy *
Noodles *      

Soups
Chicken Noodle * Tomato Cream of Chicken Vegetable *
Chicken Broth * Beef Broth * Vegetable Broth *  

Salads
Tossed Salad * Chef's Salad Grilled Chicken Salad * Potato Salad
Cottage Cheese * Fruit Plate * Cottage Cheese and Fruit Plate *  
Salad Dressing
French Italian Ranch Caesar
Thousand Island Fat-free Italian * Fat-free French * Fat-free Ranch *

Deli
Create your own sandwich:
Meat
Roast Beef Roast Turkey * Ham  
Cheeses      
American Swiss * Provolone *  
Specialty
Lettuce * Tomato * Pickle Onion *
Fillings
Tuna Salad * Chicken Salad Peanut Butter and Jelly  
Sides
Baked Potato Chips * Potato Chips Pretzels  
Bread *
White Wheat Rye  

Condiments
Salt and Pepper Mrs. Dash Regular Pancake Syrup Sugar-free Pancake Syrup
Cream Cheese, regular Cream Cheese, low-fat Sour Cream Jelly, regular
Jelly, diet Peanut Butter Brown Sugar Sugar
Honey Parmesan Cheese Mayonnaise, regular Mayonnaise, light
Ketchup Mustard Relish Lemon
BBQ Sauce Tartar Sauce Salsa Non-dairy Creamer
Margarine      

Bread Basket *
White Wheat Rye Dinner Roll
Graham Crackers Kaiser Roll Crackers  

Beverages
Milk
Skim * 2% Whole Chocolate
Lactose Free *      
Cold Drinks
Iced Tea Lemonade Fruit Punch  
Juice *
Apple Orange Cranberry Prune
Peach      
Soda
Cola, regular Cola, diet Caffeine-free Cola, diet Lemon-Lime
Vernors, regular Vernors, diet    
Hot Drinks
Coffee Decaf Coffee * Hot Tea Decaf Hot Tea *
Hot Chocolate Sugar-free Hot Chocolate    

Desserts
Cakes
Angel Food * Chocolate Cheesecake  
Pies
Apple Cherry    
Cookies
Vanilla Wafers * Peanut Butter Sugar Chocolate Chip
Oatmeal Raisin Chocolate Brownie Graham Crackers *  
Pudding *
Chocolate, regular Vanilla, regular Vanilla, sugar-free  
Ice Cream
Vanilla Chocolate Popsicle *  
Sherbet *
Orange Fruit Ice    
Gelatin *
Gelatin, regular Gelatin, sugar-free    
Yogurt *
Plain Fruited    


Comments or Special Instructions:

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* These items are Heart Healthy or available as Heart Healthy; choices for sodium/cholesterol restricted diets.