Food Questionnaire

 

Client:   

Date: 

 

*Please circle the acceptable items and add comments where appropriate.

 

MEATS:

          Y/N Beef (steak/roasts/ground round)

          Y/N Pork (chops/roasts/ribs/bacon/ham/ground, sausage)

          Y/N Veal (stew/ground/scallops)

          Y/N Lamb (chops/stew/ground/roasts)

 

Comments:_____________________________________________________________________________

 

POULTRY:

           Y/N Chicken (breasts/thighs/ground/sausage)

           Y/N Turkey (breasts/smoked/ground/sausage)

            

Comments:_____________________________________________________________________________

 

FISH/SHELLFISH:

            Y/N Fish (bass, tuna, halibut, catfish, swordfish, tilapia, snapper, salmon-farmed or fresh)

            Y/N Shrimp

            Y/N Clams (no shell)

            Y/N Scallops

            Y/N Crab

 

Comments:_____________________________________________________________________________

 

SALADS: Please X-out those items you do not want prepared.

          Y/N Fresh Green Lettuces (Romaine, spinach, escarole, red leaf, mixture, spinach, etc.)

          Y/N Fruit (cranberries, blueberries, raspberries, mango, kiwi, raisins, currants, figs, prunes, oranges, lemons, limes, etc)

           Y/N Salads as a main dish?

 

Comments: ______________________________________________________________________________________

 

 

SALAD DRESSINGS:

          Y/N Mayonnaise (based)

          Y/N Mustard (based)

          Y/N Ranch

          Y/N Vinaigrette

          Y/N French

          Y/N Oil/vinegar

          Y/N Red wine/vinegar

          Y/N Thousand Island

          Y/N Other (identify)

 

Comments:_____________________________________________________________________________

 

SOUPS:

          Y/N Creamed (name type)______________________________________

          Y/N Hot

          Y/N Cold

          Y/N Chunky

          Y/N Red meat/poultry?

          Y/N Soups as a main dish?

 

Comments______________________________________________________________________________

 

VEGETABLES: Please X-out those items you do not want prepared.

          Green (eggplant, peas, green beans, broccoli, spinach, asparagus, green bell peppers, Poblano chile peppers, Anaheim   peppers, jalapeno, cabbage, celery, Swiss chard, escarole, kale, Brussel sprouts)

          Yellow (corn, wax beans, squash, yellow bell peppers)

          Red (red cabbage, beets, tomatoes, red bell peppers, sweet potatoes/yams)

          White (cauliflower, potatoes, water chestnuts, bean sprouts, onions, mushrooms, leeks)

          Beans (black, ranch-style, pinto, kidney, lima, fava, white, cannellini)

 

Comments:_____________________________________________________________________________

 

GRAINS / PASTA:

          Y/N Rice – (white/brown)

          Y/N Pasta (white, wheat, low-carb)

          Y/N Couscous 

          Y/N Cornmeal

          Y/N Other (identify)

 

BREADS:

          Y/N Wheat

          Y/N White

          Y/N Cornbread

          Y/N Muffins

          Y/N Tortillas (corn / flour)

Comments:_____________________________________________________________________________

 

SEASONINGS: Please X-out those items you do not want prepared.

Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, curry, chili powder, celery salt, dill, garlic powder, marjoram, saffron, turmeric, File gumbo, garam masala.

 

          Fresh: garlic, parsley, cilantro, basil, sage, mint, tarragon, thyme, ginger

          Pepper- white, black or red pepper flakes, cayenne

          Salt - regular or kosher

 

Comments:_____________________________________________________________________________

 

FATS/OILS:

          Y/N Butter

          Y/N Canola Oil

          Y/N Sesame Oil

          Y/N Corn Oil

          Y/N Olive Oil (extra light, light, extra virgin)

          Y/N Vegetable Oil

          Y/N Sunflower Oil

 

Comments:_____________________________________________________________________________

         

MILK AND MILK PRODUCTS:

          Y/N Cheeses (Parmesan, cheddar, Swiss, Fontina, Asiago, ricotta, mozzarella, mascarpone

          Y/N Milk (skim, 1%, 2%, whole

          Y/N Yogurt (light / regular)

          Y/N Sour cream (light/regular)

          Y/N Half and half

 

Comments:_____________________________________________________________________________

 

EGGS:

          Y/N Whole

          Y/N Yolks only

          Y/N Whites only

          Y/N Eggbeaters substitute

 

Comments:_____________________________________________________________________________

 

OTHER:

          Y/N Tofu

          Y/N Nuts (pecans, peanuts, pine, walnuts, almonds, cashews, etc.)

 

Comments:_____________________________________________________________________________

 

List any vegetables or fruits you don’t ever want to see_______________________________

List any other food dislikes____________________________________________________________

List any known food allergies__________________________________________________________

Rate your preference for spicy foods – bland / mild / moderate/very_________________

Do you have any favorite recipes that I can prepare for you?__________________________

Cuisine: Italian / Mexican / Indian / Asian, etc.________________________________________

Type of cook-top; electric or gas range, single or double ovens, microwave capacity (small, medium, large)

House pets? (Cat(s) / Dog(s) / Bird(s)

Note:  Please determine available space in refrigerator to accommodate frozen meals. Is there a secondary refrigerator?