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Alysias Creations Personal Chef Service

Client Menu Questionnaire


Directions 1. Fill out form 2. Save file to your desktop (VERY IMPORTANT STEP!) 3. Attach this form to an email addressed to eat@alysiascreations.com Thank you for your interest in Alysias Creations Personal Chef Service. Here is your opportunity to let us know your food preferences. Please take a few minutes to fill out this questionnaire. It is a bit lengthy, but it is the best way to ensure that we deliver just what you want. We also keep this in your file and reference it to create menus for you! Client: ______________________________________________________________________ Address: ____________________________________________________________________ Home Phone: ___________________________ Cell Phone: ___________________________ Email: ______________________________________________________________________ Best weekdays for the Chef to cook in your home (if applicable):

Todays Date: ________________________________________________________________ Please list ANY known or suspected allergies for anybody in household:

Starter questions: Ethnic Cuisines - Whats your favorite??? (Italian, Mexican, Greek, Chinese, Japanese, Indianetc) __________________________________________________________________________________

Any Favorite recipes you would like prepared?

Foods/main dishes you really like:

____________________________________________________

___________________________________________________________________________________ Foods/main dishes you really dislike:

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Alysias Creations Personal Chef Service

Client Menu Questionnaire


What is your preference for spicy foods? Bland Mild Moderate Spicy How do you want your meals packaged? Single Two-person Family portions

Which appliance are you going to use to heat your meals? Oven ____ Microwave ____ Does your oven maintain an accurate temperature? Yes ___ No ___ What kind of Freezer space is available to store your entrees? Attached to Refrigerator ____ Stand Alone ____ Where is your Fuse/Breaker Box located? ______________________________________ Do you want meals prepared in your home, or prepared and then brought to you?

If you want meals prepared in your home, do you have a security system that requires a pass code to enter your home if you will not be there? Yes ___ No ___ May we cook with Wine and/or Liquors? Yes ___ No ___

Please indicate items you like


Beef: Steak Roast Ground round Flank steak Short ribs Veal: Stew Ground veal Scaloppini Pork: Chops Tenderloin Ribs Bacon Ham Ground pork Sausage Lamb: Chops Stew Ground Roasts

Meatloaf Meat & vegetable/pasta casseroles

Please list any meats you will not or cannot eat:_____________________________________________

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Alysias Creations Personal Chef Service

Client Menu Questionnaire


Poultry
Chicken: Boneless Bone in breast Thigh Ground Roast Turkey: Breast Smoked Ground Cutlets Sausage Chicken/turkey meatloaf Chicken/turkey and vegetable/pasta casseroles

Please list any poultry you will not or cannot eat: __________________________________________

When you eat Poultry do you prefer? Dark Meat ____ White Meat ____ Both ____

Fish/ Shellfish
Fin Fish: Salmon Tilapia Haddock Cod Catfish Bass Mahi Mahi Tuna steak Shell Fish: Shrimp Scallops Lobster Crab, natural Crab imitation Canned tuna in oil Canned tuna in water

Please list any fish or shellfish you will not or cannot eat: __________________________________________

Salads/lettuce: Salads: Mixed greens Fruit salads Rice salads Pasta salads Salad as main entree Lettuce/Greens: Arugula Butter head Endive Escarole Frisse Iceberg Leaf lettuce Lollo rosso/mesclun Radicchio Romaine Spinach Watercress

Please list any greens you will not or cannot eat: __________________________________________

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Alysias Creations Personal Chef Service

Client Menu Questionnaire


Salad Dressings: Vinaigrette (Italian, balsamic, raspberry, citrus) Olive oil & balsamic vinegar Olive oil & lemon juice Mayonnaise based Ranch Light ranch French Honey mustard Blue cheese Thousand island Other______________

Do you eat salads as a main dish? Y N Please list any salad dressing you will not or cannot eat: ______________________________________

Soups: Creamed (name types) Hot Cold Clear broths With meat/poultry Vegetable Soup as main dish Other______________

Do you eat soups as a main dish? Y N Please list any soup you will not or cannot eat: __________________________________________

Vegetables: Artichokes Asparagus Bean sprouts Beets Bell peppers Bok Choy Broccoli Brussels sprouts Cabbage Carrots Cauliflower Celery Corn Cucumbers Dakion radish Eggplant Fennel Green beans Greens (collards etc) Kale Mushrooms Okra Onions Leeks Spinach Swiss chard Tomatoes Turnips Winter squash Yellow squash Zucchini Other __________________

Please list any vegetables you will not or cannot eat: ________________ _______________________

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Alysias Creations Personal Chef Service

Client Menu Questionnaire


Fruits: Apple Apricot Avocado Banana Blackcurrant Blueberry Cherry Coconut Cranberry Fig Grapefruit Grape Guava Kiwi Lemon Lime Loganberry Mango Melon Nectarine Orange Papaya Peach Pear Persimmon Pineapple Plum Pomegranate Quince Other __________________ Please list any fruit you will not or cannot eat: __________________________________________ Grains & Potatoes: Rice: White rice Brown rice Wild rice Rice pilaf Risotto Pasta: Regular pasta Whole wheat pasta Fresh pasta Other Grains: Barley Buckwheat Bulgur Polenta Potatoes: Sweet potatoes, Yams Yellow potatoes Red potatoes Russet potatoes White potatoes Fingerling potatoes Blue potatoes

Other __________________

Please list any grains or potatoes you will not or cannot eat: ___________________________________ Beans: Black-eyed peas Cannelloni Garbanzo Kidney Lentils

Lima Peas Pinto soybeans

Other___________________

Please list any beans you will not or cannot eat: __________________________________________

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Alysias Creations Personal Chef Service

Client Menu Questionnaire


Breads: White Wheat Multigrain Rolls Biscuits Muffins Cornbread Pita Naan (sweet, savory) Paratha Tortillas Flour Whole wheat Corn Artisanal Bruschetta Foccacia Pesto Garlic, Rosemary Sourdough

Please list any breads you will not or cannot eat: __________________________________________ : Herbs: -

Basil Chives Cilantro Dill garlic

Italian parsley Lavender Marjoram Mint Oregano

Rosemary Sage Thyme Tarragon Other___________________

Please list any herbs you will not or cannot eat: __________________________________________ Spices: Allspice Anise Bay leaf Caraway Cardamom Celery seed Chervil Cinnamon Cloves Coriander Cumin Curry powder Dill seed Fennel seed Garlic powder Ginger powder Lemon grass Mustard seed/powder Nutmeg Paprika Peppermint Poppy seed Saffron Spearmint Turmeric Wasabi. Other ________________

Please list any spices you will not or cannot eat: __________________________________________

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Alysias Creations Personal Chef Service

Client Menu Questionnaire


Salt: & Pepper: Pepper: Black White Cayenne, Red pepper flakes Cajun seasoning Salt: Regular, Kosher, Sea salt, Garlic salt -

Other ________________

Please list any spices you will not or cannot eat: __________________________________________ Sweeteners:

White sugar Brown sugar Raw sugar

Honey Maple syrup Fruit juices/applesauce, Agave

Splenda Sweet & low Equal Other ________________

Please list any sweeteners you will not or cannot eat: ________________________________________ Fats/Oils: Olive oil: Extra virgin Light Regular Butter Margarine Smart balance Other Oils: Canola oil Grape seed oil Sesame oil Vegetable oil Shortening Walnut oil. Peanut oil Other ________________

Please list any fats/oils you will not or cannot eat: ________________________________________ Dairy Products: Milk: Whole 2% 1% Skim Cream Half & half

Yogurt: Regular Low fat Non-fat

Others: Cottage cheese Cream cheese Sour cream Crme fraiche.

Please list any dairy products you will not or cannot eat: _____________________________________

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Alysias Creations Personal Chef Service

Client Menu Questionnaire


Cheeses: Asiago Brie Cheddar Colby-jack Feta Fontina Fresh mozzarella Fresh ricotta Goat cheese Gorgonzola Gouda Gruyere Havarti Humboldt fog Jarlsberg Manchego Mascarpone Monterey jack Mozzarella Muenster Parmigiano Regggiano Pepper jack Provolone Queso fresco Stilton Swiss.

Please list any cheeses you will not or cannot eat: __________________________________________ Eggs & Soy: Eggs: Whole Yolks only Whites only Egg substitute Tofu: Firm Extra firm, Soft Silken Soy based products Gluten-free Other _________________

Please list any eggs and soy you will not or cannot eat: ______________________________________ Nuts & Seeds: Almonds Cashew Chestnut Hazelnut Pecan Peanut Pistachio Pine nuts Macadamia Walnuts. Flaxseed, Poppy, Pumpkin, Sesame, Sunflower.

Please list any eggs and soy you will not or cannot eat: ______________________________________ Miscellaneous: Olives: Green Black Kalamata Others: Capers Jalapenos Artichoke hearts Other __________________

Any other misc items you can think of that you do not enjoy:___________________________________ Thank you. Directions 1. Fill out form 2. Save file to your desktop (VERY IMPORTANT STEP!) 3. Attach this form to an email addressed to alysiagpersonalchef@gmail.com

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