HOME ABOUT THE SERVICE MENU SELECTIONS QUESTIONNAIRE FAQ THE CHEF Client Evaluation Questionnaire     Name:   Email:   Phone: ()-   Best time to reach you:   How did you find out about our service? -- Select One -- Referral Yellow Pages Internet Healthy Dining Newsletter Other   1. Do you enjoy?   Soups or salads as a main dish? Hot Cold     Pastas as entrees? Hot Cold   2. How many times per week to you enjoy?   Beef Pork Turkey     Chicken: White Dark Both Skin Skinless     Fresh Fish/Seafood     List favorite types of fish so that I may select the freshest catch of the day from your list of preferences?       Vegetarian Entrees   Preference: Lacto Ovo   Vegan Organic     OK foods: Honey Refined Sugar Grains, beans, buglar, etc.         Nuts: Peanuts   Walnuts Pecans Almonds       Cheeses: Real   Low-fat Non-fat   3. Are you sensitive to? Garlic Onions Bell Peppers Mushrooms Soy   4. List any other sensitivities?   5. Are you lactose intolerant? Yes No   6. Are you allergic to anything?   7. Vegetables: Like   Dislike   8. Chop Portions? Small Large   9. Are there any other flavors or foods that you just plain dislike?   10. May I cook with wine and/or liquors? Yes No   11. Medical Conditions   Diabetic Cardiac Condition High Blood Pressure High Cholesterol   Salt: No Light Fat: No Low   12. Are you trying to lose weight? Yes No   13. Would you like portion control? Yes No   14. What International Cuisines do you enjoy?   Mexican Thai French Italian Oriental     Others Describe:   15. Spicy Food Scale   Bland Mild Medium Hot Laser   16. Do you like to eat bread or rolls with your entrees? Yes No   16. If so, what kinds? 17. Do you like to eat tossed salads with your entrees? Yes No   18. What are your favorite greens? 19. Favorite dressings? 20. How do you prefer entrees packaged? Individual For two Family Style 21. List any favorite family dishes or recipes that I can prepare for you:   22. How do you prefer to heat/reheat meals? Stovetop Oven Microwave 23. Do you have a microwave oven? Yes No   24. Stove and Oven: Gas Electric   Are all stove burners functioning? Yes No     Oven functioning and accurate? Yes No   25. May I see your freezer? Yes No   26. What are your favorite restaurants?   27. What type of desserts do you enjoy?       CGI Scripts Courtesy of Jon's CGI-Scape.