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Food Questionnaire

Here is your opportunity to let me know what you prefer in your customized menu. Check preferences and add comments, as needed. Be sure to tell me if there are allergies or foods you NEVER want to see!

 *Olive oil is used most often in cooking, with occasional uses of other oils (walnut, sesame, peanut, etc.). Butter is also used occasionally. A canola oil cooking spray is also used.

**All grains will be whole grain, unless otherwise specified.

Name *
E-mail Address *
What type of diet are you looking for?
  Any
  Vegan
  Low Calorie
  Vegetarian
  Low-fat
  Low Cholesterol
  Special Diet (Diabetic, Gluten-free, Lactose-intolerant, etc.)
  Other
Other (specify)
Meats
  Beef
  Veal
  Pork
  Lamb
  Meatloaf
  Casseroles
Comments
Poultry
  Chicken
  Turkey
  Meatloaf
White meat
Dark meat
Both
Seafood
  Fish
  Scallops
  Crab
  Shrimp
Comments
Salads
  Fresh Green
  Fruit
  Pasta
  Main Dish
Salad Dressings Use your own
Made by chef
Comments
Soups
  Creamed
  Cold
  Hot
  Chunky
Comments
Vegetables
  Green(peas, green beans, spinach or other greens, asparagus, cabbage, celery, etc.)
  Red (pimento, red cabbage, beets, tomatoes, sweet potatoes, etc.)
  Yellow (corn, wax beans, squash, etc.)
  White (cauliflower, potatoes, parsnips, onions, mushrooms, leeks, etc.)
  Beans (black, pinto, garbanzo, etc.)
  Peppers (sweet, hot)
Comments
Fruit
  Citrus
  Stone
  Berries
  Fresh
  Dried
  Preserves
  Cooked in a main dish
Comments
Grains
  Rice
  Quinoa
  Couscous
  Corn
  Wheat
Whole Grain
Refined
Comments
Breads (Whole Grain, unless otherwise specified)
  Biscuits
  Rolls
  Cornbread
  Tortillas
Comments
Seasonings
List any herbs or spices you don't want, including garlic, pepper or low-salt
Milk and Milk Products
  Cheeses (parmesan, cheddar, swiss, goat, etc.)
  Sour cream
  Yogurt
  Milk
Percent Fat Non-fat
1%
2%
Whole
Eggs Whole
Whites only
Yolks only
Substitute
Other
  Tofu
  Nuts (pecans, almonds, walnuts, etc.)
Favorite Cuisines
  Mexican
  Italian
  Indian
  Asian
Other (specify)
Breakfast (Whole grain unless otherwise specified)
  Waffles
  Muffins
  Quiches
Do you prefer mild, moderate, or hot spiciness?

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