Name *

First Name

Last Name

Primary Phone *

(###)

###

####

Other Phone

(###)

###

####

How do you want your food cooked? *

Salt

Light Salt

No Salt

Low-Fat

No Fat

Low-Calorie

What is your 'garlic tolerance'? *

None

Light

Medium

Heavy

Is it OK to use alcohol in your cooking? *

Yes

No

Do you like nuts in main dishes, sides, salads? *

Yes

No

Please check condiments that you LIKE to eat:

Ketchup

Yellow Mustard

Dijon Mustard

BBQ Sauce

Mayonnaise

Please check vegetables you LIKE to eat (check all that apply) *

Acorn Squash

Arugula

Asparagus

Avocado

Beets

Bell Peppers

Broccoli

Broccoli Rabe

Brussel Sprouts

Butternut Squash

Carrots

Cauliflower

Chives

Cilantro

Cooked Spinach

Corn

Cucumber

Dill

Eggplant

Endive

Frisee

Garlic

Green Beans

Green Cabbage

Iceberg Letuce

Kohlrabi

Leeks

Mixed Greens

Mushrooms

Onions

Oregano

Parsley

Peas

Potatoes

Pumpkin

Radicchio

Radish

Red Cabbage

Romaine Lettuce

Rosemary

Rutabaga

Snap Peas

Snow Peas

Spaghetti Squash

Spinach/Baby Spinach

Sweet Potatoes

Tomatoes

Turnips

Yellow Squash

Zucchini

How do you like your vegetables cooked? *

Crisp

Tender

Soft

Do you like vegetarian entrees? *

Yes

No

Do you eat eggs? *

Yes

No

Please check meats you LIKE to eat (check all that apply) *

I don't eat meat

Beef

Lamb

Pork

Veal

How do you prefer your steak cooked?

Rare

Medium

Well

Please check poultry you LIKE to eat (check all that apply) *

I don't eat poultry

Chicken

Turkey

White meat

Dark meat

Please check fish/seafood you LIKE to eat (check all that apply) *

I don't eat fish/seafood

Bass (Black or Wild Striped)

Cod

Crab

Halibut

Lobster

Monkfish

Salmon

Scallops

Shrimp

Snapper

Tilapia

Tuna

Please check fruits you LIKE to eat (check all that apply) *

I don't eat fruit

Apples

Apricots

Bananas

Cranberries

Figs

Grapes

Peaches

Plums

Raisins

Please check beans/legumes you LIKE to eat (check all that apply) *

I don't eat beans

Baked Beans

Black Beans

Edamame

Kidney Beans

Lima Beans

Pinto Beans

Refried Beans

White Beans

Please check nuts you like to eat (check all that apply) *

I don't eat nuts

Almonds

Cashews

Peanuts

Pecans

Pine Nuts

Pistachios

Walnuts

Please check grains you LIKE to eat (check all that apply) *

I don't eat grains

Barley

Brown Rice

Bulgur

Corn Grits

Freekeh

Lentils

Oats

Polenta

Quinoa

Spelt

Wheat

Wheat Berries

White Rice

Wild Rice

Please check pasta you LIKE to eat (check all that apply) *

I don't eat pasta

White

Wheat

Protein Enriched

Fiber Enriched

Soba (Buckwheat)

Gluten-Free

Please check dairy/dairy alternatives you LIKE (check all that apply) *

Almond Milk

Blue Cheese

Butter

Cheddar Cheese

Coconut Milk

Feta

Goat Cheese

Goat Yogurt

Milk

Mozzarella

Rice Milk

Ricotta Cheese

Sheepmilk Cheese

Sour Cream

Soy Milk

Swiss cheese

Yogurt

Do you like soups/stews? (check all that apply) *

Yes

No

Main

Side

Vegetarian

Creamy

With Meat/Poultry

What types of ethnic cuisine do you enjoy? (check all that apply) *

Asian

Cajun

Caribbean

French

Greek

Indian

Italian

Latin

Mediterranean

Middle Eastern

None

Southwest/Mexican

Spanish

What is your spicy food tolerance? *

Bland

Mild

Medium

Hot

Painful!

Do you like sweet and savory combinations? *

(e.g. Apricot glaze on meat/poultry)

Yes

No

Do you enjoy bread or rolls with your entrees? *

Yes

No

Do you like salads? (check all that apply) *

Yes

No

Entree

Side

How would you like your meals packaged? *

Single Servings (Entrees and sides packaged together)

Double Servings (2 servings per package)

Family Servings (4 servings per package)

Would you prefer meals packaged to heat in: *

Microwave

Oven

No preference