| Full Name |
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| Email Address: |
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| Address Line |
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| City/State/Postal Code
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| Daytime Phone |
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| Evening Phone |
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| Please give us the email address
you'd like your menus to be emailed to? |
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| How did you find us? Through a
Search Engine? Personal Chef Network? Referral? If from any
other source...do tell! |
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| How often would you like our
service? |
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| Are you following any special diet
plan? |
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| Do you have any medical conditions
that should be addressed when planning your menus?
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| Do you or any members of your
family have any food allergies? |
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| How would you classify your style
of eating? Low Carbohydrate? Low calorie? Low fat? Gourmet?
Organic? |
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| How often per week do you eat the
following meats? |
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| Beef? |
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| Chicken? |
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| Pork? |
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| Veal? |
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| Lamb? |
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| Turkey? |
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| Duck? |
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| Fish / Seafood? |
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| Do you enjoy light or dark meat
with regard to chicken or turkey? |
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| Do you dislike any of the
following? Cod, sole, salmon, sea bass, scallops, snapper,
shrimp, prawns, tuna, clams, mussels, crab or smoked salmon?
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| How many times per week do you
enjoy seafood?
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| How many times per week do you
enjoy seafood? Do you prefer vegetarian food? If so, how
many times per month? |
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| How many times per week do you
enjoy soup? |
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| Do you like soup as a main course?
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| What is your favorite soup?
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| Do you like salads? |
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| Salads as a main dish?
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| What salad ingredients do you like?
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| What are your favorite main dishes?
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| Are there any favorite dishes you
miss eating and would like me to prepare for you?
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| How many times per week do you
enjoy pasta as an entree? |
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| Are there any fruits or vegetables
that you dislike and would not want used in your entrees?
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| Are there any other flavors or
items that you do not want used in your menus?
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| Do you like
grains/nuts/beans/cheese? |
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| Are you lactose intolerant?
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| What are your favorite fruits?
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| What fruits do you dislike?
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| What are your favorite vegetables?
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| What vegetables do you dislike?
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| May I cook with wines and liquors?
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Yes
No
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| I use an abundance of fresh herbs
in my menus. Do you dislike any of the following herbs?
Basil, thyme, sage, rosemary, oregano, tarragon, cilantro,
watercress, chives, parsley, dill, thai basil, mint,
caraway, cumin or fennel? |
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| Do you dislike any of the
following? Garlic, ginger, lemon grass, sesame oil,
horseradish or chilies? |
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| Do you dislike any of the following
cuisines? French, Italian, Greek, Thai, Indian, Japanese or
Chinese? |
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| Where do your tastes fall on the
spicy scale? Bland, mild, medium, hot or extra-hot?
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Bland
Mild
Medium
Hot
Extra Hot
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| Would you like me to prepare foods
that you can grill or barbecue? |
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| How do you like your steak
cooked?rare, medium rare, medium or well done?
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| What is your favorite cookie,
muffin and cake?
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| What's your favorite dessert?
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| Tell us what your three favorite
restaurants are in the Portland metro or Vancouver area.
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| If you are a single person can you
provide space for 20 frozen entree's in your freezer (about
2 cubic feet)? |
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| Tell us about the kitchen where we
will be working. How many stove top burners do you have? Are
all burners working? How many ovens do you have? Are the
ovens operational?Do you have an indoor or outdoor grill?
How many refrigerators or freezers do you have?
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| Do you own a microwave oven?
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Yes
No
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| May we use your appliances such as
blenders, food processors ETC.? |
Yes
No
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| Please tell us what your five
favorite entrees choices are. |
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| Please let us know here about any
comments, questions or medical concerns that we need to know
about. |
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