FREE ASSESSMENT Edible Excellence - Personal Chef Service
 
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Free Assessment

Please take the time to go over and fill out this detailed assessment form which will give us a better idea of what foods might suit you and your family best. * items are required

Date: 09-03-10
Name: * Address: *
Telephone: * E-Mail: *
Do you enjoy soups or salads as a Main Dish? Yes No
Do you enjoy soups? Hot Cold
Do you enjoy Pastas as Entrées? Yes No
How many times per month do you enjoy the following?
Beef

Chicken

White
 Pork

Dark

Fish/Seafood
 Turkey
Do you enjoy Vegetarian/Vegan Entrées? Yes No

If yes, which ones?
Grains
Nuts		 Beans
Cheese		 Bulgur
Are you sensitive to any of the following? Garlic Onions Mushrooms
Bell Peppers

List any other sensitivity:
Are you Lactose Intolerant? Yes No
Do you have any food allergies? Yes No

If yes, please list:
Are there any Fruits or Vegetables that you dislike? Yes No

Likes:


Dislikes:
Are there any other flavors or foods you just plain dislike? Yes No

Dislike:

What Global Cuisines do you enjoy? Mexican Oriental Italian French
Other
May I cook with Wine and/or Liquors? Yes No
Any Medical Conditions?
If yes, check all that apply:		 Yes No
Diabetic Cardiac Condition
High Blood Pressure High Cholesterol
Low Salt No Salt
Low Fat No Fat
Are you trying to lose weight? Yes No
Would you like Portion Control? Yes No
Spicy Food Scale: Bland Mild Medium Hot
How would you like your Entrées packaged? Individual For 2 Family Style
Would you prefer disposable or reusable containers? Disposable Reusable
Which appliance will you be using to heat your food? Microwave Oven