Food Questionnaire

Client Name(s)

Other Adults (names):

Children – Names & Ages:

Birthdays:

Pets – Names & Types:

Address:

Phone Number:

E-Mail:

How did you hear about Farmhouse Culinary?

MEATS: Place an "x" in the boxes of the items that you like only and place notes in the comments section

Beef (steak/roasts/ground)

Pork (chops/roasts/ribs/bacon/ham/ground)

Lamb (chops/stew/ground/roasts)

Meatloaf

Meat and vegetable/pasta casseroles

Comments:

POULTRY

Chicken (breasts/thighs/ground, etc) white, dark or mixed

Turkey (breasts/smoked, ground, etc.)

Chicken or turkey meatloaf

Chicken or turkey and vegetable/pasta casseroles

Comments:

FISH/SHELLFISH:

Fish (bass, yellowtail, orange roughy, catfish, snapper, etc)

Shrimp

Scallops

Crab

Lobster

Comments:

SALADS:

Fresh Green (choice of greens/lettuces, such as Romaine, red leaf, butter, mixture, spinach, etc

Fruit in your salad

Pasta in your salad

Salads as a main dish

Comments:

SALAD DRESSINGS:

Ranch

Vinaigrette (any)

Comments:

SOUPS/STEWS:

Creamed (name type in comments)

Hot

With meat/poultry?

Soups/Stews as a main dish?

Comments

VEGETABLES: (List vegetables that you will not eat in comments)

Green (peas, green beans, spinach, asparagus, peppers, cabbage, pea pods, celery, Brussels sprouts, mustard greens/greens, broccoli, zucchini, avocadoes, poblanos)

Yellow (corn, wax beans, squash, peppers

Red (pimento, red cabbage, beets, tomatoes, peppers, sweet potatoes/yams, carrots

White (cauliflower, potatoes, parsnips, bean sprouts, mushrooms, leeks)

Beans (black, ranch-style, pinto, kidney, lima, white, pink, black-eyed peas, split peas

Capers, black olives, green olives, coconut, artichokes, eggplant

Comments:

GRAINS:

Rice (brown, white, wild, pilaf)

Couscous

Quinoa

Farro

Comments:

BREADS:

Wheat

White

Rolls (white or wheat, sourdough, etc.)

Biscuits

Cornbread

Muffins

Pancakes/Waffles

Tortillas (corn, white or wheat)

Comments:

SEASONINGS: (List seasonings you will not eat in the comments)

Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, celery, chili powder, curry

Fresh garlic, parsley

Pepper – white, black or red

Salt – Kosher (food is prepared very low in salt so that you may season to taste)

Comments:

FATS/OILS:

Butter

Olive Oil and other healthy oils (sesame, walnut, pecan, avocado, truffle, etc)

Comments:

MILK AND MILK PRODUCTS: (List any cheeses you do not like in the comments)

Cheeses (parmesan, cheddar, Swiss, muenster, fontina, blue, feta, and goat, etc.

Milk (skim, 1%, 2%, whole)

Yogurt

Sour cream

Comments:

EGGS:

Whole

Yolks only

Comments:

OTHER:

Dried Fruits

Tofu

Nuts (pecans, peanuts, walnuts, almonds, cashews, etc)

Pizza

Comments:

Fruits disliked

List any known food allergies

Spicy foods – bland/mild/moderate/very hot

Do you have any favorite recipes that I can prepare for you?

Cuisines liked (Mexican/Curries/Italian, Home-style)

Favorite food/restaurants

Which meals (Breakfast, Lunch, Dinner, Snack, Dessert)

Number days a week you/family will eat prepared food:

Number of servings for each meal

Portion control (yes or no)

Service Frequency (weekly, bi-weekly, monthly)

Sides with service (1 side with each entree or 2 with each entree)

JOIN US FOR THE SUMMER SEASON — FRESH, LOCAL, CHEF-PREPARED MEALS!

Food Questionnaire