Chef Services – Food Questionnaire

Completing this form allows me to discover your food preferences. Please fill out this to the best of your ability. If you have any questions, please contact me.

Personal Chef Services Food Questionnaire

* Name

First

Last

Other Adults (Names)

Children (Names and Ages)

Full Name

Street Address

Address Line 2

City

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State

ZIP Code

Preferred Contact Number

What is the best way to reach you?

Text

Phone

Email

Email Address

How did you hear about A Natural Chef?

Facebook

Instagram

Google

Referral

Retreat

Other

If you Googled us, what keywords did you use?

Please check the boxes of the items that you/your family like and place notes in the comment section below.

Meats

Beef (steak, roasts, ground round, ribs)

Pork (chops, roasts, ribs, bacon, ham, ground)

Lamb (chops, stew, ground, roasts)

Meatloaf

Bison

Comments:

Poultry

Chicken (breasts, thighs, ground)

Chicken - white meat

Chicken - dark meat

Chicken - mixed (bone or boneless)

Turkey

Chicken or turkey meatloaf or meatballs

Comments

Fish/Shellfish

Fish (bass, yellowtail, halibut, salmon, snapper, cod, flounder, etc.)

Shrimp

Scallops

Crab

Lobster

Comments

Salads

Fresh green (choice of greens/lettuces such as romaine, red leaf, bibb, spinach, mixture, etc.)

Mixed grain, vegetable, fruit, bean, or legume-based salads

Fruit, nuts/seeds, or cheese in your salad

Salads as a main dish

Comments

Salad Dressings

Creamy (Ranch, Caesar, French, etc.)

Vinaigrette (any)

Comments (other dressings?)

Soups/Stews

Creamed

Chowders

Bone broths/vegetable broths

Broth-based soups

With meat/poultry?

Soups/Stews as a main dish?

If you checked creamed, name types:

Comments

Vegetables

Green (peas, green beans, spinach, asparagus, peppers, cabbage, pea pods, celery, Brussels sprouts, mustard greens/greens, broccoli, zucchini, avocados, poblanos, okra, kale, swiss chard, bok choy)

Yellow (corn, wax beans, squash, peppers)

Red (pimento, red cabbage, beets, tomatoes, peppers, sweet potatoes/yams, carrots)

White (cauliflower, potatoes, parsnips, water chestnuts, bamboo shoots, bean sprouts, onions, mushrooms, leeks)

Beans (black, ranch-style, pinto, kidney, lima, chickpeas, cannellini beans, white, pink, black-eyed peas, split peas)

Capers, black olives, green olives, coconut, artichokes, eggplant)

List vegetables you or specific family members will NOT eat in the comments below.

Comments

Grains

Rice (brown, white, wild, pilaf)

Couscous

Quinoa

Farro

Millet

Bread

Cornbread

Muffins

Pancakes/waffles

Tortillas (corn, white or wheat, grain-free, almond flour)

Comments

Seasonings

Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, celery, chili powder, curry

Fresh garlic, parsley

Pepper - black, white, or red

Salt - sea salt or pink salt (food is prepared low in salt so that you may season to taste)

List any seasonings you will not eat in the comments below.

Comments

Fats/Oils

Butter

Olive and other healthy oils (sesame, walnut, avocado, hemp seed, etc.)

Comments

Is it okay to cook with wine?

Yes

No

Milk and Milk Products / Dairy-Free Products

Cheeses (Parmesan, cheddar, Swiss, muenster, fontina, blue, feta, goat, etc.)

Milk, non-dairy milk (skim, 1%, 2%, whole)

Yogurt, non-dairy yogurt, cashew/coconut milk

Sour cream

List any you do not like in the comments.

Comments

Eggs

Whole

Yolks only

Other

Dried Fruits

Nuts/seeds (pecans, peanuts, walnuts, almonds, cashews, Brazil, hemp seeds, sesame seeds, chia seeds, flax seeds, etc.)

Comments

Fruits disliked:

List any known food allergies:

Spicy foods - bland, mild, moderate, or very hot?

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

Cuisines liked (Mexican, curries, Italian, home-style, etc):

Favorite food/restaurants:

Meals (breakfast, lunch, dinner, snacks, dessert):

Number of days per week you/your family will eat prepared food:

Number of servings for each meal:

Portion control:

Yes

No

Service Frequency

Weekly

Bi-weekly

Bi-monthly

Monthly

Sides with service

1 side with each entrée

2 sides with each entrée

Organic groceries?

Yes

No

Comments/questions:

Enter your initials to complete your questionnaire:

ALL DONE! Have other questions or concerns? Please feel free to list any other concerns in the comments above or by contacting me.

I look forward to cooking for and meeting you!