Food Questionnaire

Client(s) Name(Required)

Children Names & Ages

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number(Required)

Email(Required)

How Did you hear about Chef Kev(Required)

Desired Start Date(Required)

MEATS (Please check the boxes of the items that you like only)

Beef (steak/roasts/ground round) Steak cooked

Pork (chops/roasts/ribs/bacon/ham/ground)

Lamb (chops/stew/ground/roasts)

Meat and vegetable/pasta casseroles

Meat Comments

POULTRY (Please check the boxes of the items that you like only

Chicken (breasts/thighs/ground, etc.) white, dark, or mixed

Turkey (breasts/smoked/ground, etc.)

Chicken or turkey meatloaf

Chicken or turkey and vegetable/pasta casseroles

Poultry Comments

FISH/SHELLFISH: (Please check the boxes of the items that you like only

Fish (bass, yellowtail, orange roughly, catfish, snapper, etc.)

Shrimp

Scallops

Lobster

Crab

Fish/Shellfish Comments

SALADS: (Please check the boxes of the items that you like only

Fresh Green (choice of greens/lettuces, such as Romaine, red leaf, bibb, mixture, spinach, etc.)

Fruit in your salad

Pasta in your salad

Salads as a main dish

Salad Comments

SALAD DRESSINGS: (Please check the boxes of the items that you like only

Ranch

Vinaigrette (any)

SOUPS: (Please check the boxes of the items that you like only

Creamed

Hot

With Meat/Poultry?

Soups/ Stews as a main dish

Soup Comments

VEGETABLES: (Please check the boxes of the items that you like only

Green (peas, green beans, spinach, asparagus, peppers, cabbage, pea pods, celery, brussel sprouts, mustard greens/greens, broccoli, zucchini, avocadoes, poblanos, okra)

Yellow (corn, wax beans, squash, peppers)

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

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

Beans (black, ranch-style, pinto, kidney, lima, white, pink, black-eyed peas, split peas)

Capers, black olives, green olives, coconut, artichokes, eggplant

Vegetable Comments

GRAINS: (Please check the boxes of the items that you like only

Rice (brown, white, wild, pilaf)

Couscous

Quinoa

Farro

Grain Comments

BREADS: (Please check the boxes of the items that you like only

Wheat

White

Rolls (white or wheat, sour dough, etc.)

Biscuits

Cornbread

Muffins

Pancakes/ Waffles

Tortillas (corn, white or wheat

Bread Comments

SEASONINGS: (Please check the boxes of the items that you like only

Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, celery, chili powder, curry

Fresh garlic, parsley

Pepper—white, black or red

Salt—Kosher (food is prepared very low in salt so that you may season to taste)

Seasoning Comments

FATS / OILS: (Please check the boxes of the items that you like only

Butter

Olive Oil and other healthy oils (sesame, walnut, pecan, avocado, truffle, etc.)

Fats/Oils Comments

MILK AND MILK PRODUCTS: (Please check the boxes of the items that you like only

Cheeses (parmesan, cheddar, Swiss, muenster, fontina, blue, feta and goat etc.)

Milk (skim, 1%, 2%, whole)

Yogurt

Sour Cream

Milk Product Comments

EGGS: Please check the boxes of the items that you like only

Whole

Yolks Only

OTHER: Please check the boxes of the items that you like only

Dried Fruits

Tofu

Nuts (pecans, peanuts, walnuts, almonds, cashews, Brazil, etc.)

Pizza

Comments

Please list any dietary restrictions/food allergies, if any(Required)

Fruits Disliked(Required)

Spicy foods - bland/mild/moderate/very hot(Required)

Do you have any favorite recipes that I can prepare for you?(Required)

Cuisines liked (Mexican/Curries/Italian, Home-style)(Required)

Favorite food/restaurants(Required)

Which meals (Breakfast, Lunch, Dinner, Snacks and Dessert)(Required)

Number days a week you/family will eat prepared food(Required)

Please enter a number from 1 to 7.

Number of servings for each meal(Required)

Please enter a number from 1 to 100.

Portion control (yes or no)(Required)

Yes

Service Frequency (weekly, bi weekly, bi monthly, monthly)(Required)

Sides with service ( 1 side with each entrée or 2 with each entrée)(Required)

1 Side

2 Sides

Organic or Non-organic groceries(Required)

Orgainc

Non-Organic

No Preference

Food Questionnaire

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