Food Questionnaire
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Email *
INTRODUCTION
Your First Name
Your Last Name
Other Adults (Names)
Children (Names and Ages)
Address
City
State
Zip Code
Preferred Contact Number
What day and time is best to reach you by phone?
Preferred Email Address
How did you hear about Plant-Based Eatz?
If you Googled us, what were the keywords you used? **Please check the boxes of the items that you like only and place notes in the comment section.**
**For the following questions, please only check the boxes of the items that you like. Please place notes in the comment section that follows each category.**
SALADS
COMMENTS - SALADS
SALAD DRESSING
COMMENTS - SALAD DRESSING
SOUPS/STEWS
If you checked creamed, name type(s)
COMMENTS - SOUPS/STEWS
VEGETABLES (List vegetables you will not eat in the comments)
COMMENTS - VEGETABLES
GRAINS
COMMENTS - GRAINS
BREADS
COMMENTS - BREADS
SEASONINGS (Please list seasonings you will not eat in the comments)
COMMENTS - SEASONINGS
FATS/OILS
COMMENTS - FATS/OILS
Is it okay to cook with wine?
Clear selection
Plant-Based MILK and Plant-Based MILK PRODUCTS (List any plant-based cheeses you do not like or are not willing to try in the comments)
Clear selection
COMMENTS (PLANT-BASED MILK PRODUCTS)
EGG SUBSTITUTE (Just Egg or Chickpea)
Clear selection
OTHER
COMMENTS - EGGS AND OTHER
FRUITS DISLIKED
SPICY FOODS (Check all that you like)
Do you have any favorite recipes that I can prepare for you as a plant-based dish?
CUISINES LIKED (Mexican/Curries/Italian, Home-style)
FAVORITE FOOD/RESTAURANTS
WHICH MEALS
NUMBER OF DAYS A WEEK YOU/FAMILY WILL EAT PREPARED FOOD
NUMBER OF SERVINGS FOR EACH MEAL
SERVICE FREQUENCY
SIDES WITH SERVICE
ORGANIC OR NON-ORGANIC GROCERIES
LIST ANY KNOWN FOOD ALLERGIES
ENTER YOUR INITIALS TO COMPLETE YOUR QUESTIONNAIRE
Have any questions or concerns? Feel free to leave any questions you don't know the answer to blank or give us a call. We look forward to setting up your meal delivery service that fits best with your lifestyle and dietary needs and preferences!
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