When dinning out, what restaurants do you frequent?
Do you enjoy soups as your main entree'
Yes
No
What type of soups do you enjoy?
Hot
Cold
Creamed
Chunky
Clear
With meat/poultry
Do you enjoy the following?
Beef (steak/roasts/ground round)
Meatloaf
Pork (chops/roasts/ribs/bacon/ham/ground/sausage/tenderloin)
Veal (stew/ground/scallops)
Lamb (chops/stew/ground/roasts)
Turkey (breasts/smoked/ground/scalloped/sausage)
Chicken (breasts/thighs/legs/whole/ground/bone-in/skin-on)
Chicken - White meat
Chicken - Dark meat
Fish (orange roughy, catfish, snapper, grouper, trout, tilapia, halibut, salmon, sole, swordfish, flounder, mahi mahi, ahi tuna, cod, tuna fish)
Shellfish (shrimp, scallops, crab, clams, mussels)
Additional comments on the foods above?
Do you enjoy vegetarian entrees?
(Tofu, Soy-based meatless products, meatless meals i.e. vegetable lasagna)
Yes
No
Sometimes
Additional comments on vegetarian entrees?
Do you enjoy the following?
Grains (Rice {brown,white, wild}, couscous, quinoa, lentils, wheat{berries, bulgar, kasha}, corn {hominy, grits, polenta}, pasta {semolina, multigrain}, barley, farro)
Beans (black, ranch-style, pinto, kidney, lima, white, pink, refried, garbanzo)
Nuts (pecans, peanuts, walnuts, almonds, cashews, Brazil, etc.)
Cheese (Parmesan, cheddar, Swiss, Muenster, Monterey Jack, fontina, feta, goat, ricotta, mozzarella, bleu, cottage cheese)
Additional comments on the foods above?
Are you dairy intolerant?
(Milk {skim, 1%, 2%, whole}, Yogurt {fat free, low fat, regular}, Sour Cream {fat free, low fat, regular}, half and half, cream, crème fraiche)
Yes
No
Additional comments on dairy foods?
Vegetables you really enjoy
Acorn Squash
Artichokes
Arugula
Asparagus
Avocado
Beans (Kidney, Garbanzo, Black, White, etc)
Beets
Bell Peppers
Bok Choy
Broccoli Rabe
Broccoli/Broccolini
Brussels Sprouts
Butternut Squash
Cabbage
Capers
Carrots
Cauliflower
Celery
Collard Greens
Corn
Cucumbers (Gherkin, English)
Edamame
Eggplant
Fennel
Garlic
Ginger
Green Beans
Herbs (Parsley, Cilantro, Thyme, Rosemary, Chives, Basil, Mint, Sage, Tarragon, Dill, Oregano etc)
Jalapeno Peppers (also Habanero, Serrano, Chipotle)
Kale
Leek
Lemongrass
Lettuce
Mushrooms (Porcini, Button, Shiitake, etc)
Olives (black, green, kalamata)
Onions
Parsnips
Peas
Pearl Onions
Poblano Peppers
Potatoes (Russet, Red, Yukon Gold, etc)
Pumpkin
Shallots
Spinach
Sugar Snap Peas
Summer Squash
Sweet Potatoes
Swiss Chard
Tomatoes (Cherry, Grape, Roma, etc)
Zucchini
Fruits you really enjoy
Apples
Apricots
Bananas
Blackberry
Blueberries
Cherries
Coconut
Figs
Lemon
Lime
Mango
Oranges
Pineapple
Strawberries
Additional comments? (List any fruits or vegetables you will not eat)
What condiments do you like?
Mustard
Mayonnaise
Sweet salsa/chutney
Savory salsa - mild
Savory salsa - medium
Savory salsa - hot
Ketchup
Herbed butter
Are you intolerant/allergic to anything, or do you have food sensitivities?
*
Are there any fruits or vegetables that you particularly like or dislike?
Are there other flavors that you particularly dislike?
May I cook with alcohol?
*
Yes
No
Do you have any of the following conditions?
*
Diabetes
Heart Problems
High blood pressure
Require Light salt
Require No salt
High cholesterol
Require Low fat
Require No fat
None of the Above
Additional comments
Are you trying to lose weight?
Yes
No
Are you on a particular diet?
Do you like the following cuisines?
Mexican/Latin
Thai
Chinese
Japanese
Indian/Curries
Mediterranean
Spanish
Other
Spices you really enjoy
Allspice
Basil
Cardamom
Cayenne
Celery
Chili powder
Cinnamon
Cloves
Coriander (cilantro)
Cumin
Curry
Dill
Dried oregano
Fennel
Garam masala
Nutmeg
Paprika
Parsley
Rosemary
Saffron
Tarragon
Thyme
Indicate the level of spiciness you prefer
Bland
Mild
Medium
Hot
Number of servings per meal
*
Ages of children
Name
*
First Name
Last Name
Email
*
Phone
*
Country
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