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| Address: |
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Please check preferences and add comments.
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| MEATS: |
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Beef (steak/roasts/ground round) |
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Pork (chops/roasts/ribs/bacon/ham/ground) |
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Veal (stew/ground/scallops) |
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Lamb (chops/stew/ground/roasts) |
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Meatloaf |
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Meat and vegetable/pasta casseroles |
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Comments:
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| POULTRY: |
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Chicken (breasts/thighs/ground/etc.) |
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Turkey (breasts/smoked/ground/scalloped/etc.) |
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Duck |
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Chicken or turkey meatloaf |
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Chicken or turkey and vegetable/pasta casseroles |
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Comments:
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| FISH/SHELLFISH: |
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Fish (bass, yellowtail, orange roughly, catfish, snapper) |
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Shrimp |
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Scallops |
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Crab |
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Lobster |
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Tuna (fresh, canned, in oil or water?) |
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Comments:
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| SALADS: |
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Fresh Green (choice of greens/lettuces, such as Romaine, red leaf, bibb, mixture, spinach, etc.) |
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Fruit |
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Rice |
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Pasta |
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Jello |
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Salads as a main dish? |
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Comments:
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| SALAD DRESSINGS: |
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Mayonnaise |
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Ranch |
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Vinaigrette |
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French |
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Oil/vinegar |
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Red wine/vinegar |
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Thousand Island |
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Other (identify) |
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Comments:
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| SOUPS: |
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Creamed (name type) |
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Hot |
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Cold |
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Chunky |
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Clear |
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With meat/poultry? |
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Soups as a main dish? |
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Comments:
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| VEGETABLES: |
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Green (peas, green beans, spinach, asparagus, peppers, cabbage, pea pods, celery, mustard greens) |
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Yellow (corn, wax beans, squash, peppers) |
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Red (pimento, red cabbage, beets, tomatoes, peppers, sweet potatoes/yams) |
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White (cauliflower, potatoes, parsnips, water chestnuts, bean sprouts, onions, mushrooms, leeks) |
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Beans (black, ranch-style, pinto, kidney, lima, white, pink) |
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Comments:
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| GRAINS: |
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Rice |
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Couscous |
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Quinoa |
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Wheat/granola |
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Corn |
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Other (identify) |
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Comments:
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| BREADS: |
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Wheat
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White |
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Rolls (white or wheat, sour dough, etc.) |
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Biscuits |
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Cornbread |
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Muffins |
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Pancakes |
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Waffles |
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Tortillas |
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Comments:
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| SEASONINGS: |
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Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, celery, chili powder |
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Exotic Spices such as curry and saffron |
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Fresh herbs including garlic |
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Pepper - white, black or red |
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Salt - regular or Kosher |
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Comments:
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| FATS/OILS: |
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Butter |
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Margarine |
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Canola Oil |
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Corn Oil |
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Olive Oil |
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Vegetable Oil |
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Sunflower Oil |
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Lard |
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Shortening |
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Comments:
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| MILK AND MILK PRODUCTS: |
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Cheeses (parmesan, cheddar, swiss, muenster, fontina, etc.) |
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Milk (skim, 1%, 2%, whole) |
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Cottage cheese |
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Yogurt |
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Sour cream |
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Half and half |
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Comments:
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| EGGS: |
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Whole |
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Yolks only |
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Whites only |
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Eggbeaters substitute |
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Comments:
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OTHER:
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Tofu |
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Soy-based meatless products |
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Nuts (pecans, peanuts, walnuts, almonds, cashews, Brazil, etc.) |
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Comments:
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DIETARY PREFERENCES:
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I would like to follow an Organic Program |
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I would like to follow a Low Carb Program |
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I would like to follow a Low Fat Program |
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I would like to follow a Low Sodium Program |
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I would like to follow a Sugar Free Program |
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I would like to follow a Gluten Free Program |
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Comments:
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| FINAL COMMENTS: |
Food Preference Questionnaire