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Grocery List

- Client Services

Please use the form below to provide information about your family and to let us know your needs and preferences with non-perishable groceries, paper and cleaning supplies, toiletries, wipes and any other specific needs. Please make an ppointment by phone or email before completing this form. Call if you need help: 585-586-5139.
submit grocery list after confirming an appointment time
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Date REQUIRED Please fill out this field. Please enter a date.
- Number of Adults (18-64) REQUIRED Please fill out this field.
- Number of Seniors (age 65+) REQUIRED Please fill out this field.
- Numbers of Infant-Toddler Children (0-4) REQUIRED Please fill out this field.
- Number of Elementary-Middle School Kids (5-13) REQUIRED Please fill out this field.
- Number of Teens (14-17) REQUIRED Please fill out this field.
- Please note: In the comments section, please note any special dietary needs or restrictions. Availability of particular food items vary--we will do our best to meet your needs.
- Vegetables and Fruits -- Choose up to 3 per person in household Pasta Sauce Diced tomatoes Mixed vegetables Peas Green beans Beets Corn Carrots Yams White potatoes Pears Peaches Mixed fruit Applesauce Pineapple Cranberry sauce
- Protein & Dairy -- Select up to 3 per person in household Milk Peanut butter Canned tuna Canned chicken Pinto beans Black beans White beans Garbanzo beans Kidney beans Soup Broth Beef stew Chili Hash Spaghetti O's Canned Ravioli Baked beans
- Breakfast -- 2 per person in household Instant oatmeal Cheerios Raisin Bran Bran flakes Shredded Wheat Corn flakes Cinnamon Toast Crunch Honey Bunches of Oats Life Fruit Loops Frosted Flakes Pancake mix Maple syrup Breakfast Bars Pop-Tarts
- Grains & Sides - Choose up to 3 per person in household Pasta Mac & Cheese Rice Ramen/Instant Noodles Potato side Pasta side Gluten-free pasta Instant potatoes Stuffing Gravy
- Condiments Jelly Salad dressing Cooking oil Ketchup Mayonnaise Mustard BBQ sauce Soy sauce Pickles
- Baking -- one of each as checked Flour Sugar Cookie/Brownie Mix Cake mix Salt Pepper
- Beverages - one of each as checked Coffee Decaf coffee Tea Hot cocoa mix Boost/Ensure Juice
- Snacks -- one per person in household Granola bars Protein bars Crackers Fruit snacks Popcorn Nuts
- Household items Toilet paper (4) Paper towels (2) Tissues (2) Napkins (1) Laundry detergent (1) Dish detergent (1) Storage - plastic wrap, aluminum foil or baggies (1) Bleach Sanitizing wipes or spray Floor cleaner Hand soap
- Toiletries - one of each as checked Bar soap Body wash Deodorant Shampoo Conditioner Toothbrush Feminine Hygiene pack Hand sanitizer
- Diapers or Pull-Ups with wipes Newborn diapers Size 1 diapers Size 2 diapers Size 3 diapers Size 4 diapers Size 5 diapers Size 6 diapers 3T/4T Pull-Ups 4T/5T Pull-Ups L/Xl Pull-Ups Wipes (2) Formula -- please specify brand and type in comments
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