YOUR PERSONAL CHEF

522 California Ave.

Reno, Nevada 89509

775-324-0228 Phone & 775-324-2998 Fax

Food Questionnaire

Client’s Name__________________________________________

Mailing Address________________________________________

________________________________________

Home Phone Number___________________________________

Other Phone Number (work or cellular)__________________________

Fax Number____________________________________________

Family Make-up (#Adults - #Children)___________________________

Best Day of the Week to Deliver___________________________

Number of Times Per Month You’d Like Delivery ___________

Here is your opportunity to let us know what you prefer in your customized menu. Please circle your preferences and add comments. Please cross through any foods that you don’t like and never wish to see.

1. Side salads – rice / pasta / fruit / jello________________________________

2. Salads – main dish________________________________________________

3. Soups – main dish – cold / hot______________________________________

4. Meatless Meals (vegetarian)_________________________________________

5. Pasta – entrée – cold / hot__________________________________________

6. Macaroni & Cheese – old style / spicy / new world with veg’s_____________

7. Beans & Grains – quinoa / bulgur / barley_____________________________

8. Nuts – walnuts/ cashews / almonds / hazelnuts_________________________

9. Cheese___________________________________________________________

10. Quiche___________________________________________________________

11. Chicken – breasts/ thighs/ ground___________________________________

12. Turkey – breasts/ thighs/ ground____________________________________

13. Beef – steak/ roasts/ ground round____________________________________

14. Pork – roasts/ chops/ ground/ ribs/ bacon_____________________________

15. Lamb – chops/ stew/ ground________________________________________

16. Fish______________________________________________________________

17. Shrimp___________________________________________________________

18. Tuna – canned water packed_________________________________________

19. List any vegetables or fruits you don’t ever want to see____________________

20. List any other food dislikes___________________________________________

21. List any known food allergies_________________________________________

22. Rate your preference for spicy foods – bland/ mild/ moderate/ very________

23. International cuisine – Mexican/ Curries/ Italian/ etc.___________________

24. Additional comments_______________________________________________

_________________________________________________________________________________________