General Information for Client
* First Name:	* Last Name:	Spouse Name:	* Address 1:
Address 2:	* City:	* Zip:	e-mail:
* Home Phone:	Office:	Mobile:	Fax:
Meal Style: Entree & 2 sides Entree & 1 side
Do you have any medical conditions that need to be addressed?
Diabetes High Blood Pressure High Cholesterol		Other:
* Family Members in Household:
Name:	Age(if child):	Name:	Age(if child):
Name:	Age(if child):	Name:	Age(if child):
Food Information
* What is your "Salt level": High Medium Low None		* What is your "Fat level": High Medium Low None
* What is your "Garlic level": High Medium Low None		* What is your "Onion level": High Medium Low None
* What is your "Pepper/Spicy level": High Medium Low None		* Some recipes may include alcohol. Is that okay?: Yes No
Does anyone have food allergies?: Yes No		List:
* Is anyone lactose intolerant?: Yes No		If yes, can you have any dairy?
Any flavorings/spices/veggies you do not care for?: Yes No		List:
* Do you like nuts in Main Dishes, Sides or Salads?: Yes No
How do you like steak cooked? Rare Medium-Rare Medium Medium Well Well Done		How do you like lamb cooked? Rare Medium-Rare Medium Medium Well Well Done
How do you like veal cooked? Rare Medium-Rare Medium Medium Well Well Done		How do you like Pork cooked? Rare Medium-Rare Medium Medium Well Well Done
How do you like fish cooked? Medium Medium Well Well Done		How do you like shellfish cooked? Medium Medium Well Well Done
How do you like vegetables cooked? Crunchy Medium Well Done
What Cuisines do you enjoy:
Chinese French Italian Southwest/Mexican Comfort/Southern Mediterranean Latin Caribbean Indian Jewish Cajun/Creole Greek Thai Japanese
Food Preferences (Check Box if you dislike)
Meat
Chicken White	Chicken Dark	Turkey White	Turkey Dark
Chicken Skin On	Turkey Skin On
Fish
Red (Salmon/Tuna)	White	Fillets	Steaks
Mild	Strong	Thick	Thin
Salad Greens
Boston	Field Greens	Endive	Red-Tipped
Escarole	Romaine
Would you prefer meals packaged to heat in Microwave or Oven
How do you want entrees/sides packaged?Single or Family Style (all servings of an item in one package)
How did you hear about my service?