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Your First Name
Your Last Name
Other Adults (Names)
Children (Names and Ages)
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.**
Fresh Green (choice of greens/lettuces, such as Romaine, red leaf, bibb, mixture, spinach, etc.)
Fruit in you salad
Salads as a main dish
COMMENTS - SALADS
Oil & Vinegar
Creamy Plant - Based Dressings (ranch, blue cheese, creamy Italian, etc)
COMMENTS - SALAD DRESSING
Soups/Stews as a main dish?
If you checked creamed, name type(s)
COMMENTS - SOUPS/STEWS
VEGETABLES (List vegetables you will not eat in the comments)
Green (peas, green beans, spinach, asparagus, peppers, cabbage, pea pods, celery, brussel sprouts, mustard greens/greens, broccoli, zucchini, avocadoes, poblanos, okra, kale, swiss chard)
Yellow (corn, wax beans, squash, peppers)
Red (pimento, red cabbage, beets, tomatoes, peppers, sweet potatoes/yams, carrots)
White (cauliflower, potatoes, parsnips, water chestnuts, bamboo shoots, bean sprouts, onions, mushrooms, leeks)
Beans (black, ranch-style, pinto, kidney, lima, white, pink, black-eyed peas, split peas)
Capers, black olives, green olives, coconut, artichokes, eggplant
COMMENTS - VEGETABLES
Rice (brown, white, wild, pilaf)
COMMENTS - GRAINS
Pancakes / Waffles
Tortillas (corn, white or wheat)
COMMENTS - BREADS
SEASONINGS (Please list seasonings you will not eat in the comments)
Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, celery, chili powder, curry
Fresh garlic, parsley
Pepper - white, black or red
Salt - Kosher (food is prepared very low in salt so that you may season to taste)
COMMENTS - SEASONINGS
Olive Oil and other healthy oils (sesame, walnut, pecan, avocado, truffle, etc.)
COMMENTS - FATS/OILS
Is it okay to cook with wine?
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)
Plant-based Cheeses (parmesan, cheddar, Swiss, muenster, fontina, blue, feta and goat etc.)
Plant “Milk” (almond, soy, hemp, oat, cashew, hazelnut, etc)
Vegan Sour Cream
COMMENTS (PLANT-BASED MILK PRODUCTS)
EGG SUBSTITUTE (Just Egg or Chickpea)
Nuts (pecans, peanuts, walnuts, almonds, cashews, Brazil, etc.)
COMMENTS - EGGS AND OTHER
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)
NUMBER OF DAYS A WEEK YOU/FAMILY WILL EAT PREPARED FOOD
NUMBER OF SERVINGS FOR EACH MEAL
SIDES WITH SERVICE
1 side with each entree
2 sides with each entree
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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This form was created inside of Houndstooth Media Group.