When beginning service, I generally sit down with you, or just fill this out by phone and breeze through the questionnaire. If you wish to fill it out on your own, I have included it here.

Client Food Questionnaire

If interested in beginning service, please copy and paste your completed questionnaire into a Word Document and email to:

Ckbusiness@aol.com or simply print it out and give it to me in person or mail. Thanks.

Name _______________________________ Date __________Phone__________________

Address___________________________________________________________________

Email_____________________________________

Here is your opportunity to let me know what you prefer in your customized menu. Please check preferences and add comments if desired. Please cross out any foods that you don't like and never wish to see in any way, shape or form!

MEATS:

__ Beef (steak/roasts/ground round or sirloin/chili)

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

__ Veal (chops/stew/ground/scallops)

__ Lamb (chops/stew/ground/leg/roasts)

__ Meatloaf

__ Sausage

Comments:

POULTRY:

__ Chicken/Cornish hens (breasts/thighs/ground/chili etc.)

__ Turkey (breasts/ground/chili etc.)

__ Chicken Sausage/Brats (in chili generally)

     Duck/Duck Breast

Comments:

FISH/SHELLFISH:

__ Fish (bass, orange roughy, snapper, salmon, swordfish, halibut, tilapia, tuna, flounder, sole, cod, mahi-mahi, trout etc.)

__ Shrimp

__ Scallops

__ Clams, Mussels

__ Crab/Lobster

__ Tuna (canned, in oil or water for South Beach Diet)

Comments:

SALADS:

__ Fresh Greens (Romaine, red leaf, bibb, mixture, baby greens, arugula, spinach, etc.)

__ Fruit

__ Pasta

__ Jello (for South Beach Diet)

__ Salads as a main dish? With poultry or meat?

Comments:

SALAD DRESSINGS:

__ Wasabi Mayonnaise

__ Honey Mustard

__ Honey Hazelnut

__ Ranch

__ Vinaigrette (with balsamic or red wine vinegar)

__ French

__ Oil/vinegar with garlic and herbs

__ Thousand Island

__ Other (identify)

Comments:

SOUPS:

__ Creamed (name type)______________________________________

__ Hot

__ Cold

__ Chunky

__ Clear

__ with meat/poultry?

__ Soups as a main dish?

__ Extra soup for the week? (A minimal extra charge)

Comments

VEGETABLES:

__ Green (peas, green beans, broccoli, spinach, asparagus, peppers, cabbage, pea pods, green onions, celery, arugula, swiss chard, kale, scallion, cucumber etc.)

__ Yellow (corn, wax beans, squash, peppers etc.)

__ Red (red cabbage, beets, tomatoes, peppers, carrots, sweet potatoes/yams etc.)

__ White (cauliflower, potatoes, parsnips, water chestnuts, bean sprouts, onions, shallots, turnips, mushrooms, leeks etc.)

__ Beans (black, pinto, kidney, lima, white, pink, butter, chili, chick peas, lentils etc.)

__ other (eggplant, zucchini, olives, capers, caperberries, greenpeppercorns, artichoke hearts, avocado etc.)

Comments:

GRAINS:

__ White Rice/Brown Rice/Rice Pilaf/Wild Rice

__ Couscous

__ Quinoa

__ Wheat/Granola

__ Barley

__ Corn

__ Polenta

__ Pasta (entrée? hot? cold?)

__ Other (identify)

Comments:

BREADS:

__ Wheat

__ White

__ Rolls (white, wheat, sour dough, croissants, etc.)

__ Cornbread

__ Biscuits

__ Muffins

__ Pizza

Comments:

SEASONINGS:

__ Oregano, sage, basil, rosemary, tarragon, fennel, cumin, turmeric, cilantro, garlic powder/salt, paprika, parsley, celery, chili powder, thyme, chive, curry, ginger, cinnamon, nutmeg, dill etc.

__ Fresh garlic

__ Pepper—white, black or red

__ Salt—regular/ Kosher/ Sea salt

Comments:

FATS/OILS:

__ Butter

__ Margarine

__ Canola Oil

__ Corn Oil

__ Extra Virgin Olive Oil

__ Vegetable Oil

__ Sunflower Oil

__ Safflower Oil

__ Peanut Oil

__ Sesame Oil

__ Basil Oil (all flavored and herb oils - rosemary, chili, walnut, tarragon etc.)

__ Grapeseed Oil

__ Shortening

Comments:

MILK AND MILK PRODUCTS:

__Cheeses (parmesan, cheddar, swiss, mozzarella, goat, feta, muenster, blue, fontina, monterey jack, gruyere, ricotta etc.)

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

__ Cottage cheese

__ Yogurt

__ Sour cream

__ Half and half

__ Heavy Cream

Comments:

EGGS:

__ Whole

__ Yolks only

__ Whites only

__ Eggbeaters substitute

Comments:

OTHER:

__ Vegetarian entrees

__ Tofu

__Nuts (pecans, peanuts, peanut butter, macadamias, walnuts, hazelnuts, almonds, cashews, Brazil, pine nuts, pistachios, etc.)

Comments:

Favorite Foods ___________________________________________________

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

List any other food dislikes____________________________________

List any known food allergies_________________________________

Dietary Requirements/Preferences _________________________________________

Rate your preference for spicy foods - bland/mild/moderate/very__________________________

Do you enjoy wine with your meals? Dessert? _______________________________________

Is it ok to use alcohol in your meals (always cooked off)? ____________________________________

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

International cuisine? - Mexican/Middle Eastern/Italian/French/Asian/Jewish/Indian, etc. ________________

Do you prefer home-style or gourmet meals? Or both? ________________________________

What kind of portion size do you like? – small/medium/large ____________________________

What is your favorite restaurant? _______________________________________________

Describe a typical meal for you _________________________________________________

How do you want your food packaged? – single (1 person only) /double/family-style servings etc.  _________

Any additional comments, food allergies, etc.?  _______________________________________

___________________________________________________________________________

Date _______________ Signature___________________________

If interested in beginning service, please copy and paste your completed Questionnaire into a Word Document and email to:

ckbusiness@aol.com

Thanks!

 Carol Killon – CK Gourmet