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New Client Assessment Form
Booking a Service with Cayli Rae's Kitchen
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone number
*
Your answer
First day available for delivery?
*
MM
/
DD
/
YYYY
Address for delivery
*
Your answer
Are you diabetic?
*
Yes
No
Other:
Any medical conditions I should know about?
Your answer
Do you follow a specific diet?
Your answer
Do you have any allergies?
*
Yes
No
Other:
Any medications that may contraindicate with certain foods?
Your answer
Are you lactose-intolerant?
*
Yes
No
Other:
Any food sensitivities? (like garlic, pepper, cucumber?)
*
Yes
No
Other:
How did you find out about my services?
*
Facebook
Instagram
Friend
APPCA (American Personal and Private Chef Association)
Other:
What appliance is preferred for heating food?
*
Oven
Microwave
Stove Top
No preference
Other:
Do you have a freezer or fridge thermometer?
Both
Fridge
Freezer
No
Clear selection
Do you have an extra fridge or freezer to store your meals?
Yes
No
Other:
Clear selection
Do you enjoy meatless entrees?
*
Yes
No
Maybe
What type of pastas, grains and rice do you enjoy if any?
Your answer
What kind of fish do you enjoy, if any?
Your answer
What kind of meat do you enjoy, if any?
Grass Fed Beef
Organic Chicken Breast
Organic Chicken Thighs
Natural Pork
Natural, No Sugar Added, Bacon
Organic Turkey
Natural Duck Breast
Organic, Cage Free, Eggs
Other:
Do you like meat substitutions?
*
Yes
No
Maybe
Do you like mushrooms?
*
Yes
No
Maybe
What cuisines do you enjoy?
Your answer
Do you have a preference on milk?
Dairy Milk
Almond Milk
Coconut Milk
Oat Milk
Soy Milk
Hemp Milk
No Preference
Other:
How spicy do you like your food?
*
Not spicy at all
Mild
Medium
Hot
Very Hot
Other:
Are there any flavors or particular foods that you just plainly dislike?
Your answer
Do you like garlic and onions?
*
Yes
No
Other:
Do you enjoy soups, chilis or stews as a main dish?
*
Yes
No
Maybe
Do you enjoy salads as a main dish?
*
Yes
No
Maybe
What kind of cheese do you enjoy?
Sharp Cheddar
Mild Cheddar
Mozzarella
Goat Cheese
Feta
Brie
Parmesan
All
Other:
May I cook with wine/liquor?
*
Yes
No
What are some of your favorite desserts?
Your answer
Do you have a preference on salt intake?
*
No salt
Low salt
No preference
Other:
Do you have a preference on sugar intake?
No sugar
Low sugar
Regular is fine
Honey, maple, or natural alternatives only
Other:
Clear selection
Do you have a preference on water source?
*
Filtered water only
Purified water only
No preference
Other:
THE FOLLOWING QUESTIONS ARE FOR STATISTICAL PURPOSES ONLY:
How many hours a week do you spend menu planning?
Your answer
How many hours per week do you spend grocery shopping?
Your answer
How many hours a week do you spend cooking?
Your answer
How many hours a week do you spend cleaning the kitchen?
Your answer
What are some of your favorite restaurants?
Your answer
Is there any other information that you think would be helpful?
Your answer
Are you looking for a 1, 2, 3, 4, or 6 week delivery rotation?
Every week
Bi-Weekly
Every 3 weeks
Once a month
Every 6 weeks
Not sure yet
Other:
Clear selection
Thank you for your interest in Cayli Rae's Kitchen!
I will use this information to curate a menu specific to your needs.
Send me a copy of my responses.
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