Personal Chef Services Questionnaire If you are interested in the Personal Chef services, please fill out this questionnaire so that we have a base to work out the details and create your meal plan. Name *Address *City, State, ZIP *Phone *Email *Prefered Method of Communication EmailPhoneStart Date of Personal Chef Services Number Serving Does anyone in the household have any food allergies, sensitivities, intolerances or dietary constraints? *NoneLow-CholesterolGluten-FreeLow-FatLow-SaltVegetarianVeganDiabeticDairy-FreeOtherAny weight-management goals (to lose, gain weight)? List your favorite foods, flavors, ingredients, etc. List any foods you prefer to avoid How much do you like or dislike the following?1=Like very much, 2=Like, 3=Depends, 4=Dislike, 5=Can’t / Won’t eat. Thai 12345Chinese 12345Japanese 12345French 12345Italian 12345Greek 12345Vegetarian 12345Sushi 12345Indian 12345What is the level of spiciness that you prefer? BlandMildMediumHotVery HotMay I cook with alcohol? YesNoOtherPlease rank your preference for each of the following:1 = Most Important, 2 = Very important, 3 = Important, 4 = Somewhat Important, 5 = Not important at all Healthy 12345Quick 12345Easy 12345Cost 12345How often do you prefer the following: 1 = Every day 2 = Occasionally (2-3x / week) 3 = Once a week 4 = Once a month 5 = Never Salad 12345Soups 12345Pasta 12345Rice/Grains 12345Potatoes 12345Vegetables 12345Poultry 12345Pork 12345Beef 12345Lamb 12345Veal 12345Meatless 12345Fish/ Shellfish 12345Do you have favorite dishes you would like me to cook? How would you prefer to re-heat your meals? OvenMicrowaveNo Preference/ FlexibleOtherIs your stovetop: GasElectricIs your oven: GasElectricIs your oven: Functioning and accurateFunctioning but not sure if accurateNot functioningOtherOther Comments: Any other information you want to pass along to Chef Rolf? VerificationPlease enter any two digits with no spaces (Example: 12) *This box is for spam protection - please leave it blank: Share this page!FacebookTwitterGoogle +1PinterestEmailMoreLinkedInDiggStumbleUponRedditTumblr
