Primal Chef Dietary Intake
The purpose of this form is to gather as much information as possible at one time to ensure appropriate meals are prepared. Please be as thorough as possible when completing this form
What is your name?
In general, what diet do you follow?
Low fat / low calorie
No strict diet, just prefer overall healthy food
Please list ALL dietary restrictions, intolerances, and allergies
In general, describe the way you like to eat
Describe your preferred average breakfast
Describe your preferred average lunch
Describe your preferred average dinner
Describe your preferred average snacks
Describe your preferred desserts
Are you open to trying new foods and trusting the chef to make it taste good?
Please indicate which ingredients you WILL eat
Legumes, beans, lentils
Soy Sauce (Regular)
Soy Sauce (Gluten free Tamari)
Sesame oil, seeds, tahini
Wine (red, white, sake, mirin, etc - alcohol cooked off)
Chili oil (nightshade)
Hot sauces (nightshade)
Sugar alcohols (Swerve, stevia, Xylitol, Monk fruit, erythritol, etc)
Tapioca & Cassava starch / flour
Almond flour / milk / butter / other almond products
Coconut flour / milk / butter / other coconut products
White rice / rice noodles / rice flour
Gluten-free grains (brown rice, millet, quinoa, buckwheat, corn, etc)
Garlic, onions, shallots
Do you like your steaks, burgers, chops, roasts, etc cooked to
Do you eat dairy?
Do you typically eat
Do you like spicy food?
Do you eat nightshade vegetables?
What are your favorite foods or ingredients?
What are your LEAST favorite foods or ingredients? Also mention if there are any foods you absolutely will NOT eat
What style of food is preferred?
Fine dining (Plated)
Casual (Family style)
What are your favorite cuisines?
Middle eastern / Mediterranean
Cajun / Creole / New Orleans
We typically shop at Whole Foods. When available, do you prefer
All organic produce, 100% grass-fed meat, pastured pork, chicken, eggs, wild fish, REGARDLESS OF PRICE (if available)
Balance of cost, quality, sourcing, and availability (Maybe not 100% organic / grass-fed meat but still Whole Foods quality)
Never submit passwords through Google Forms.
This form was created inside of Primal Chef.