CLIENT FOOD INTERVIEW
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1 CLIENT FOOD INTERVIEW If you are interested in starting service with Annapolitan Palate please complete this form and return to: We look forward to working with you. Name: Phone: Address: City: State: Zip: # Adults in Home: # Children: Ages: Monday Delivery Thursday Delivery Days of Service (circle): Interested in Service Starting Date: Delivery Time of Day Preferred: AM Midday PM Dietary Needs: Low Sodium Vegetarian / Vegan / Pescatarian Gluten Free Low cholesterol Diabetic Other ** ALLERGIES: WHO: WHAT? ** ALLERGIES: WHO: WHAT?
2 Favorite Foods NoNo s (What you do not ever want) Vegetables / fruits Meats: Cheese: Other: List any other food dislikes Preferences: Prefer Heavier: Fish Menu Meat Menu Vegetable Menu Starch Menu Preference for spicy foods - bland/mild/moderate/very Preference for meat temps - Rare MR Medium MW Well Cuisine Not Interested In? Mexican / Middle Eastern / Italian / French / Asian / Jewish Indian / American etc. Traditional or Creative Gourmet meals? Or both? Do you enjoy wine with your meals? Dessert? Is it ok to use alcohol in your meals (always cooked off)? Do you have any favorite recipes that I can prepare for you? Favorite Childhood meal? What is your favorite restaurant? Describe a typical meal for you
3 It is vital you be as honest and specific as possible. Circle or items you are interested in for your menus. Strikethrough anything you are not interested in. MEATS: Beef (steak/roasts/ground round or sirloin/chili) Pork (chops/roasts/ribs/bacon/ham/ground/ch ili) Veal (chops/stew/ground/scallops) Lamb (chops/stew/ground/leg/roasts) Game / Exotic Meats ( Bison / Caribou / Moose / Venison ) Sausage FISH/SHELLFISH: Fish (bass, orange roughy, snapper, salmon, swordfish, halibut, tilapia, tuna, flounder, sole, cod, mahi-mahi, trout, rockfish, red snapper, skate, grouper, catfish, wahoo etc.) Shrimp Scallops Clams, Mussels Crab/Lobster Tuna (canned, in oil or water for South Beach Diet) SALADS: POULTRY: Chicken/Cornish hens (breasts/thighs/ground/chili etc.) Turkey (breasts/ground/chili etc.) Chicken Sausage/Brats (in chili generally) Duck/Duck Breast Game / Exotic (Quail / Ostrich / Pheasant) Fresh Greens (Romaine, red leaf, bibb, mixture, baby greens, arugula, spinach, etc.) Fruit Pasta Mayo Based / Vinegar Base / Natural Juices Salads as a main dish? With poultry / meat / Fish / shellfish
4 SALAD DRESSINGS: Honey Mustard Balsamic Black walnut Ranch Vinaigrette (balsamic / red wine vinegar/ raspberry / apple cider) French Oil/vinegar with garlic and herbs Thousand Island Other (identify) SOUPS: Creamed (name type) Hot Cold (Gazpacho / Melon / Cucumber) VEGETABLES: Green (peas, green beans, broccoli, spinach, asparagus, peppers, cabbage, pea pods, green onions, celery, arugula, swiss chard, kale, scallion, cucumber etc.) Yellow (corn, wax beans, squash, peppers etc.) Red (red cabbage, beets, tomatoes, peppers, carrots, sweet potatoes/yams etc.) White (cauliflower, potatoes, parsnips, water chestnuts, bean sprouts, onions, shallots, turnips, mushrooms, leeks etc.) Beans (black, pinto, kidney, lima, white, pink, butter, chili, chick peas, lentils etc.) other (eggplant, zucchini, olives, capers, caperberries, greenpeppercorns, artichoke hearts, avocado etc.) Chunky Clear with meat/poultry? Soups as a main dish? Extra soup for the week? (A minimal extra charge) Lunch to go? Comments
5 GRAINS: White Rice/Brown Rice/Rice Pilaf/Wild Rice Couscous Quinoa Wheat/Granola Barley Corn Polenta Pasta (entrée? hot? cold?) Gluten Free Pasta Other (identify) BREADS: Wheat White Rolls (white, wheat, sour dough, croissants, etc.) Cornbread Biscuits Muffins Pizza / Flatbread FATS/OILS: Butter Margarine Canola Oil Corn Oil Extra Virgin Olive Oil Vegetable Oil Sunflower Oil Safflower Oil Peanut Oil Sesame Oil Basil Oil (all flavored and herb oils - rosemary, chili, walnut, tarragon etc.) Grapeseed Oil Shortening Truffle oil SWEETENERS: White Sugar / Brown Sugar Splenda / Stevia Honey / A guava
6 MILK AND MILK PRODUCTS: Cheeses (parmesan, cheddar, swiss, mozzarella, goat, feta, muenster, blue, gorgonzola, fontina, monterey jack, gruyere, ricotta etc.) Milk (skim, 1%, 2%, whole) Cottage cheese Yogurt Sour cream Heavy Cream Half and half OTHER: Vegetarian entrees Tofu Nuts (pecans, peanuts, peanut butter, macadamias, walnuts, hazelnuts, almonds, cashews, Brazil, pine nuts, pistachios, etc.) SEASONINGS: Oregano, sage, basil, rosemary, tarragon, fennel, cumin, turmeric, cilantro, garlic powder/salt, paprika, parsley, celery, chili powder, thyme, chive, curry, ginger, cinnamon, nutmeg, dill etc. Fresh garlic Pepper white, black or red Salt regular/ Kosher/ Sea salt EGGS: Whole / Boiled Yolks only Whites only Eggbeaters substitute Any additional comments Date Signature
-Personal Chef Service/Food Coach-
Nicole s Eat Good Feel Good Kitchen -Personal Chef Service/Food Coach- Cell 619-672 1872 nicole@nicoleegfg.com New Client Questionnaire Date: Client: Medical conditions: ( ) None ( ) Diabetic ( ) Heart
How many meals are you wanting each week? Which meals and how many per day would like? Breakfast Lunch Dinner Snacks
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Phone: 408/ Oak Place, Saratoga, CA Minimum Order May Apply. Please Call For Pricing.
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Caramelised onion, mixed cheddar cheese and mixed herbs frittata. Chorizo, avocado, plum tomato, chilli jam and rocket quesadilla
SOUP Thai courgette coconut Chilli corn chowder Harissa, butternut squash and chick pea MSD Minestrone Broccoli, caraway seed with stilton crouton FRITTATA / QUESADILLA Caramelised onion, mixed cheddar
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Checkers Catering & Special Events - Eat Well Berkeley Menu 2011 (925) Page 1
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