FOOD QUESTIONNAIRE 

NAME: *
NAME:
1. How Often Do You Have Dinner At Home? *
2. Vegetables
3. SALADS
4. SIDE DISHES
5. BEEF
6. PORK
7. LAMB
8. POULTRY
9. FISH
10. SHELLFISH
11. COMFORT FOODS
12. PASTA / SPAGHETTI
13. BEANS & LEGUMES
14. GRAINS
15. NUTS & SEEDS
(Please let us know of any Nut Allergies)
16. CHEESES
17. Would you be interested in additional meals as our healthy heart breakfast or lunch specials?
21. Rate your preference for spicy foods (overall household):
22. Do you have any favorite recipes we can prepare for you?
23. Do you have an outdoor grill and want meats prepared for grilling?
24. Ethnic foods you enjoy?
25. Seasonings, Spices & Condiments:
26. Soy Products & Meat Substitutes
27. Our Food Style Is (Check All That Apply:)
29. We Prefer:
Chicken & Asparagus In Lemon Wine Sauce

Chicken & Asparagus In Lemon Wine Sauce

Glazed Salmon

Glazed Salmon

Beef & Bean Enchilada w/ Creamy Corn

Beef & Bean Enchilada w/ Creamy Corn

Cajun BBQ Shrimp w/ Basmati Rice 

Cajun BBQ Shrimp w/ Basmati Rice 

Grilled Stuffed Pork Chop

Grilled Stuffed Pork Chop

Salmon w/ Parmesan Herb Breading and Lemon Caper Butter

Salmon w/ Parmesan Herb Breading and Lemon Caper Butter

Santa Fe Chicken Casserole

Santa Fe Chicken Casserole

Kathy's Lasagna w/ Garlic Pesto Cheese Bread

Kathy's Lasagna w/ Garlic Pesto Cheese Bread

Shepherds Pie

Shepherds Pie

Chinese Pork Roast with Orange Fried Rice

Chinese Pork Roast with Orange Fried Rice