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CLIENT INTAKE FORM
Please fill out section below with complete answers. Let's Get Personal
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Email
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Record my email address with my response
FULL NAME
*
Your answer
PHONE NUMBER
*
Your answer
ADDRESS FOR SERVICE
*
Your answer
HOW MANY PEOPLE IN YOUR FAMILY?
(Please note meals are typically made with 6-8 servings)
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2
4
6
Notes:
Required
ARE THERE ANY DIETARY OR ALLERGY RESTRICTIONS TO BE AWARE OF?
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Your answer
HOW CAN THIS SERVICE HELP YOU?
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Busy lifestyle
Food Allergies
Looking for help with health conditions
New baby
Weight Loss
Required
WHAT MEALS CAN I PROVIDE FOR YOU?
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Breakfast (Baked goods, egg bites, granola, smoothie or fresh juice etc.)
Lunch
Dinner
Other:
Required
HOW WOULD YOU LIKE YOUR MEALS PREPARED?
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fresh
frozen
Required
HOW OFTEN WOULD YOU LIKE SERVICE?
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Weekly
Bi-Weekly
Monthly
Short Term
Please explain if you have specific needs
Required
WOULD YOU LIKE ME TO SUPPLY CONTAINERS FOR YOU? OR DO YOU HAVE YOUR OWN TO USE?
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*please note if you need new containers there will be a one time fee, no mark up
Please provide glass containers
I have containers
Required
PLEASE STATE DIETARY PREFERENCES
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Vegetarian
Vegan
Dairy Free
Gluten free
Low sugar
Keto
Paleo
Egg free
Nut free
Notes
Required
PLEASE LIST ANY SPECIFIC ALLERGIES OR INTOLERANCES BELOW
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Your answer
What is your spice tolerance?
*
Please note any specific needs here.
Mild
Medium
Hot
Keep it kid friendly
Required
Please select all Meat/ Poultry / Plant-based protein items the you WILL NOT eat.
*PLEASE NOTE WE DO NOT WORK WITH PORK PRODUCTS*
Beef [roasts, steaks, stews, ground]
Lamb [chops, leg, ground]
poultry [chicken, turkey, ground]
plant-based [tofu or soy products, tempeh, legumes, seitan, wheat meat, pea proteins, jack fruit]
Other:
Do you prefer
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White Meat Chicken Breast
Dark Meat - Chicken Thigh
Please state below if you prefer "bone-in" or "boneless/ skinless
Other:
Please select all Fish/ Shellfish/ Mollusk protein items the you WILL NOT eat.
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*Preparing in season wild and sustainably caught per your preference and upon availability
White Fish [Cod, halibut, snapper, grouper]
Salmon [grilled, roasted, broiled, smoked]
Shellfish [shrimp, scallops, lobster, crab]
Other:
Required
Please select all Salad items the you WILL NOT eat
Green salads [lettuce varieties of baby greens, winter greens, romaine etc.)
Fruit in salad [seasonal fruit]
Vegetable noodle salads
Grain salads
Salads as main course
Other:
Please select all Soup/ Stew items the you WILL NOT eat
Pureed [cauliflower soup, butternut squash bisque, carrot ginger, etc.]
Broth [chicken soup, miso soup, vegetable soup]
Hearty [stew, curry etc.]
Soup as main course [such as chowder, ramen, or chili]
Other:
Please check all items that you WILL NOT eat.
If there is an item that you will not eat, please explain in the notes section below.
Green [asparagus, broccoli, celery, broccolini, peas, green beans, snap peas, zucchini]
Yellow [wax beans, summer squash, spaghetti squash, delicata squash, golden beets]
Red [beets, cabbage, carrot, butternut squash, pumpkin, red bell pepper, sweet potato, tomato, sundried tomato]
Purple/ Dark [eggplant, capers, olives]
Winter greens [arugula, brussels sprouts, bok choy, chard , collards, kale, mustard, spin-ach, watercress,]
White [cauliflower, parsnip, turnips, bean sprouts, mushrooms, leeks, onions, garlic]
Beans [black beans, white beans, red beans, cranberry beans, chickpeas, soybeans]
Other:
Please check all items that you WILL NOT eat.
If there is an item that you will not eat, please explain in the notes section below.
Citrus [grapefruit, lemon, lime, mandarins, oranges]
Stone fruit [apricots, avocados, cherries, peaches, nectarines]
Fall fruit [apples, figs, pomegranates, pears, persimmons]
Tropical [Bananas, mangos, papaya, pineapples]
Berries [Blackberries, blueberries, raspberries, strawberries]
Other:
Please check all the Herbs/ Seasoning items that you WILL NOT eat.
If there is an item that you will not eat, please explain in the notes section below.
resh herbs [parsley, tarragon, chives, oregano, basil, sage, rosemary, chervil, thyme]
spices [cumin, coriander, cardamom, chili powder, cinnamon, turmeric, ginger]
seasonings [sea salt, black pepper]
other [chili powder, paprika, red pepper flakes, white pepper]
Other:
Please check all the Grain items that you WILL NOT eat.
If there is an item that you will not eat, please explain in the notes section below.
Barley
Farro
White rice [aborrio, basmati, jasmin]
Brown Rice (GF) [basmati, jasmin]
Amaranth (GF)
Buckwheat (GF)
Corn (GF)
Millet (GF)
Quinoa (GF)
Other:
Please check all the Pantry items that you WILL NOT eat.
If there is an item that you will not eat, please explain in the notes section below.
olive oil
grapeseed oil
avocado oil
coconut oil
sesame oil
apple cider vinegar
balsamic vinegar
red wine vinegar
rice vinegar
sherry vinegar
white wine vinegar
Other:
Please check all the Pantry items that you WILL NOT eat.
If there is an item that you will not eat, please explain in the notes section below.
quiche
egg white only
hard boiled
Other:
Cuisine preference
*
flavor profiles /meals you like to eat at home, or wish to eat more of
Mexican/ Latin Flavors [tacos, fajitas, burritos, ceviche, salsa, guacamole. Cali-Mexi,
arepas, empanadas, chimichurri sauce]
Asian Fusion [flavor profile: soy sauce, sesame oil, chili, sweet, ginger, garlic, fish sauce, coconut milk, chili, lime. Noodles, rice, soups, curries]
Mediterranean - Italian/ Greek [garlic, onion, olive oil, basil, oregano. Grilled meats, sauces, pasta dishes]
Middle Eastern [olive oil, tahini sauce, oregano, lemon juice, legumes, pomegranate. Grilled meats, rice, fruits]
Americana [comfort foods, casseroles, chicken pot pie]
Indian [coriander, cumin, garlic, ginger, cardamom]
African/ Caribbean [chilis, peanuts, turmeric, cinnamon, dried fruits, marinades. Tagine, couscous, jerk chicken]
Indian [coriander, cumin, garlic, ginger, cardamom]
Vegetarian or Vegan Cuisine
other [please list below any favorite cuisines not listed here]
Other:
Required
Favorite Foods
*
Please list at least two of your favorite restaurants and specific menu items you love
Your answer
Food Quality
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Please note that I will always buy organic, free-range, good-quality products. I purchase the types of foods that you normally buy for yourself. Please check any items that apply
Organic proteins
Organic produce
Organic products [rice, dairy, oils, etc.]
Grass fed meats
Free range poultry
Wild, sustainable fish/shellfish
Conventionally grown fruits/vegetables
Conventionally raised proteins/poultry/fish
Other:
Required
Please list any grocery store preferences
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Whole Foods (or equal to based on location availability)
Trader Joes (or equal to based on location availability)
Safeway (or equal to based on location availability such as Nob Hill, Albertsons etc.)
Local Health Food Store: Share below
Other:
Required
Kitchen equipment in your home
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Please check all kitchen items you have readily available to use for meal preparation. I like to keep your kitchen as close to home as possible. I will come with my personal set of some tools as needed.
Blender
Crockpot
Cutting boards
Dishwasher
Electric stove/oven
Gas stove/oven
Food Processor
Insta Pot
Misc. kitchen tools [vegetable peeler, can opener, whisk, spatulas, tongs]
Mixer
Rice Maker
Sauce pot
Mixing bowls
Pots to boil
Stock pot
Sheet trays for oven baking
Skillet
Other:
Required
How did you hear about Joyful Culinary Creations?
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Social Media
Yelp
Google
Word of Mouth
Other
Required
Did I miss anything? Please note below
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Your answer
Is there anything else I should know before starting?
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Your answer
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