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Food Questionnaire
Page
1
of 3
Contact Information
Please enter the same info from your shipping address
Name
*
Email
*
MONDAY DELIVERY WINDOW
*
1 PM - 3 PM
11 AM - 1 PM
3 PM - 5 PM
Delivery Address
Is the delivery address different for the remainder of the week?
*
No
Yes
WEDNESDAY DELIVERY WINDOW
7 AM - 9 AM
9 AM - 11 AM
11 AM - 1 PM
1 PM - 3 PM
Wednesday's Delivery Address
FRIDAY DELIVERY WINDOW
7 AM - 9 AM
9 AM - 11 AM
11 AM - 1 PM
1 PM - 3 PM
Friday's Delivery Address
Next
Food Preferences
Do you like or dislike the following cuisines:
American
*
Yes
No
Not Sure
Asian
*
Yes
No
Not Sure
French
*
Yes
No
Not Sure
Indian
*
Yes
No
Not Sure
Italian
*
Yes
No
Not Sure
Latin American
*
Yes
No
Not Sure
Mediterranean
*
Yes
No
Not Sure
Mexican
*
Yes
No
Not Sure
Middle Eastern
*
Yes
No
Not Sure
Thai
*
Yes
No
Not Sure
Do you meals need to be kid friendly (ie. sauce on the side, simple, etc.)?
*
Yes
No
What type of proteins do you enjoy?
Chicken Breast
Chicken Dark Meat
Ground Turkey
Organic Tofu
Organic Tempeh
Organic Eggs
Lean Beef
Wild Fish
Wild Shrimp
House Made Plant Based Proteins (ie. lentil fritters, white bean meatballs, etc.)
Other
What type of seafood do you enjoy?
Salmon
Halibut
Shrimp
Mahi Mahi
Yellowfin Tuna
Cod
Other
What type of cheeses do you enjoy?
Blue Cheese
Smoked Gouda
Feta
Cheddar
Goat Cheese
Gruyere
American
Brie
Romano
Parmesan
Mozzarella
Pecorino
Swiss
Nut Cheeses (Dairy Free)
How spicy do you like your food?
*
Please select
Mild
Medium
Hot
Very Hot
Do you enjoy soups as a meal?
*
Yes
No
Cold (Gazpacho)
Hot
Do you enjoy pasta as a meal?
*
Yes
No
Cold (Pasta Salad)
Hot
Do you enjoy?
Grains
Beans/Lentils
Quinoa
Rice
Bulgur
Millet
Nuts
Do you enjoy salads as a meal?
*
Yes
No
Cold
Warm
Do you like cherry tomatoes?
*
No
Yes
Would you like a salad as a side for your meal?
*
No
Yes
Are your interested in having vegetarian or vegan meals throughout the week?
Yes
No
If yes, how many?
Please select
1
2
3
4
Are there any fruits or vegetables you particullary dislike? ( up to 3 dislikes)
Likes
Are there any flavors you particualary like or dislike?
Likes
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Healthy + Dietary Needs
Why are you interested in Kale Chef Service?
*
Do you anticipate any challenges in working with Kale Chef Service?
*
Are you allergic to anything?
*
Please select
No
Yes
Do you have any food sensitivities?
*
Please select
No
Yes
If yes, please explain
Do you have any of the following conditions?
Diabetes (type 2)
Diabetes (type 1)
High Blood Pressure
Heart Problems
High Cholesterol
Email Address
*
If yes, does it require low sodium?
No
Yes
Does it require low fat?
No
Yes
Please describe any additional current or past health concerns that influence your eating or nutritional status.
What is your typical eating pattern during the day? (check the boxes that apply to you)
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Are you trying to lose weight?
*
No
Yes
Please describe your current activity level (type(s) of activity, duration of activity, number of days/week):
Currently not active beyond normal day-to-day tasks
Is there any additional information relevant to understanding how Kale Chef Service can best serve you?
Questions/Comments
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