Name *
First Name
Last Name
Address *
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email Address *
Phone *
( # # #)
# # #
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Meat/Poultry
please check all items that you WILL eat. if there is an item that you will not eat and it is listed with items that you will eat, please explain in the notes section below
Beef [roasts, steaks, stews, ground]
Lamb [chops, leg, ground]
poultry [c
hicken, turkey, ground]
pork [chops, ham, sausage, bacon, tenderloins, roasts]
vegetarian [tofu, tempeh, lentils, saitan,]
Fish/Shellfish
White Fish [cod, flounder, tilapia, seabass, bronzino, etc]
Fish Steaks [swordfish, monkfish, ahi tuna]
Salmon [grilled, roasted, broiled, smoked]
Shellfish [shrimp, scallops, lobster, crab, etc]
Mollusks [oysters, mussels, clams]
sushi - raw
sushi - cooked only
Salad
Green salads [greek, caesar, house, etc]
Fruit in salad [strawberries, mango, apple, blueberries, etc]
chopped salads [mainly vegetable salads that have been chopped down]
vegetable noodle salads
grain salads
salads as main course
soups/stews
pureed [cauliflower soup, asparagus soup, carrot ginger, etc]
brothy [chicken soup, miso soup, vegetable soup]
stew
soup as main course
Veggies
Green [broccoli, asparagus, zucchini, peas, green beans, brussels sprouts, celery, broccolini, snap peas]
yellow [wax beans, summer squash, spaghetti squash, delicata squash, golden beets]
red [cabbage, beets, tomato, sundried tomato, red bell pepper, sweet potato, carrot, butternut squash, pumpkin]
white [cauliflower, parsnip, bean sprouts, mushroom, leek, onion, garlic]
leafy greens [kale, spinach, collards, arugula, watercress, chard, bok choy]
beans [black beans, white beans, red beans, cranberry beans, chickpeas, soybeans]
dark [eggplant, capers, olives]
grains
brown rice
white rice
farro
quinoa
millet
amaranth
buckwheat
corn
herbs/seasonings
fresh herbs [parsley, tarragon, chives, oregano, basil, sage, rosemary, chervil, thyme]
spices [cumin, coriander, cardamom, chili powder, cinnamon, turmeric, ginger]
seasonings [sea salt, black pepper]
other [chili powder, paprika, red pepper flakes, white pepper]
oils/vinegars
olive oil
grapeseed oil
avocado oil
coconut oil
sesame oil
balsamic vinegar
white wine vinegar
red wine vinegar
apple cider vinegar
rice vinegar
eggs
frittatas
quiche
whole egg
egg white only
hard boiled
soft boiled
poached
scrambled
quiche
Spice level
how spicy do you like your food? None
Mild
Medium
Hot
Cuisine preference
Mexican [tacos, fajitas, burritos, salsa, guacamole]
thai [flavor profile: ginger, garlic, shallot, fish sauce, coconut milk, chili, lime]
japanese [soy sauce, sesame oil, garlic, lime, scallion]
chinese [soy sauce, chili, garlic, ginger, honey, cashew]
korean [soy, sesame, chili, sweet]
italian [garlic, onion, olive oil, basil, oregano]
mediterranean [olive oil, oregano, lemon juice]
southern [comfort foods, casseroles, chicken pot pie]
french [garlic, onion, chervil, chives, tarragon, sauces]
indian [coriander, cumin, garlic, ginger, cardamom]
other [please list below any favorite cuisines not listed here]
If selected other, please explain
favorite foods
favorite restaurants
list at least two of your favorite places to dine out. Food Quality
I purchase the types of foods that you normally buy for yourself. Please check any items that apply
Organic proteins
Organic produce
Organic products [rice, quinoa, oils, etc]
Grass fed meats
Free range poultry
Wild, sustainable fish/shellfish
Conventionally grown fruits/vegetables
Conventionally raised proteins/poultry/fish
Other
If you selected other, please explain
Dietary preferences
Gluten free
Dairy Free
Grain Free
low carbohydrate
low sugar
low sodium
kosher
egg free
nut free
other
If you selected other, please explain
Food allergies
Please list any food allergies or intolerances
How often would you like service
Multiple times per week
Weekly
Bi-weekly
Bi-Monthly
Monthly
Kitchen equipment
Gas stove/oven
Electric stove/oven
Dishwasher
Blender
Cutting boards
Misc kitchen tools [vegetable peeler, can opener, whisk, spatulas, tongs]
Soup pot
Sheet trays for oven baking
Skillet
Sauce pot
Mixing bowls
Grill pans
Other
Please list any other kitchen tools.items if not listed above
Did I miss anything?
