(Please Check all those that apply and add any comments where needed. When completed click the submit button at the end of the questionnaire )

1.Soups:  Broth Based Cream Based No Preference
 Split-pea     Black Bean     Gumbo     Potato Leek     Broccoli   
 Minestrone   Chicken Noodle       Vegetable

 Favorites?

2. Salads :   Yes   No No Preference
Iceberg     Romaine     Spinach     Field Greens   
Favorites ? 

3. Side dishes :
Rice      Pasta       Fruit      Grains      Vegetables      Slaws    Potatoes
Comments:

4. Beef : Yes   No No Preference
Sirloin    Roast      Ground      London broil      Stew
Comments:

5. Pork: Yes   No No Preference
 Roasts    Chops    Ground     Ribs    Bacon     Ham    Tenderloin
  Pork Stew     Sausage  
Comments:

6. Chicken:   Yes   No No Preference
Breasts       Thighs      Whole roasted     Sausage  With Skin   Skinless
Comments:

7. Turkey: Yes   No No Preference
Breasts     Smoked      Cutlets     Ground      Legs       Thighs
 Sausage
Comments:

8. Fish: Yes   No No Preference
Salmon Halibut    Cod    Trout     Tuna    Swordfish     Sole
   Red snapper    Grouper
Comments:

9. Shellfish:  Yes   No No Preference    
Shrimp       Scallops     Clams     Crab   
Comments:

10. Pasta/Spaghetti:  Yes   No No Preference

Red Sauces       White Sauces       Meat Sauces    Vegetable Sauces
  String Pasta    Lasagna      Penne                            Plain Pasta        Whole Wheat / Multigrain Pasta

Comments:

11. Beans and Legumes: Yes   No No Preference
Lentils         Soy Beans        Black Beans    Peas        In Soups     In Salads
Comments:

12. Grains:  Yes   No No Preference
White Rice       Brown Rice      Quinoa  Couscous     Basmati  
Comments:

12. Nuts & Seeds: Yes   No No Preference
Walnuts   Cashews     Almonds        Hazelnuts   Pine Nuts Sesame Seeds
Macadamias    Pumpkin Seeds     Peanuts
Comments:

13. Cheeses:  Yes   No No Preference
Cheddar       Mozzarella     Parmesan     Feta      Bleu    Goat     Monterey Jack     Swiss     

Comments:

14. List any foods you DON’T EVER want to see!

15. List any foods you LOVE:

16. List any and all known FOOD ALLERGIES: (Very Important!!)

17. Rate your preference for SPICY FOODS: 
Bland           Mild           Moderate          Very  Hot    

18. Ethnic foods you enjoy: 
Chinese
Thai     
Mexican     
Indian     
Cajun      
Italian  
Middle Eastern      

19. Special dietary needs: (be specific , Lowfat, Low Sodium, Heart Healthy, Low Carb) 

When questionnaire is completed please click the Submit button below

Thank You !