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New Client Questionnaire
First name
Last name
Address
Email
Phone
What are your favorite foods or dishes?
List any allergies:
Check off the following animal proteins you enjoy.
Chicken
Turkey
Duck
Pork
Beef
Lamb
Veal
Shellfish (shrimp
Fin fish (tuna
Check off the following dairy products you enjoy.
Parmesan Cheese
Cheddar Cheese
Swiss Cheese
Mozzarella Cheese
Goat Cheese
Brie
Feta
Munster
Blue Cheese
Monterey Jack
Milk
Cottage Cheese
Yogurt
Sour Cream
Butter
Egg Whites
Egg Yolks
List any strong food dislikes:
Check off the following dishes you enjoy.
Pasta
Pasta Salads
Casseroles
Sushi
Fried Rice
Caprese
Hearty Soups
Tacos
Stir Fry
Dumplings
Check off which of the following vegetarian/vegan alternatives you enjoy.
Tofu
Tempeh
Seitan
Soy-based Meatless Products
Nut Cheeses
What cuisines do you enjoy?
Mexican
Israeli
Mediterranean
Italian
Chinese
Japanese
Thai
Indian
American
List any others:
Do you usually pair your meals with wine?
Yes
No
Are you comfortable with wine/alcohol being used to cook your food?
Which grocery stores do you typically shop at?
What are some of your favorite restaurants?
Have you tried any diets or food plans in the past?
How spicy do you like your food? 1-5
Do you have any favorite recipes that I can prepare for you?
Are there any oils that you prefer me to use over another?
What food quality do you typically purchase?
Organic proteins
Organic produce
Organic products (oil
Grass fed meats
Free range poultry
Wild
Conventionally grown fruits/vegetables
Conventionally raised proteins/poultry/fish
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