Client Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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MEATS *

Select the items that you LIKE and place notes in the comments section.

Beef (steak/roasts/ground round) Steak cooked

Pork (chops/roasts/ribs/bacon/ham/ground)

Lamb (chops/stew/ground/roasts)

Meatloaf

Meat and vegetable/casseroles

No meat

POULTRY *

Select the items that you LIKE and place notes in the comments section.

Chicken (breasts/thighs/ground, etc.)

Turkey (breasts/smoked/ground, etc.)

Chicken or turkey meatloaf

Chicken or turkey and vegetable/casseroles

No poultry

FISH/SHELLFISH *

Select the items that you LIKE and place notes in the comments section.

Fish

Shrimp

Scallops

Crab

Lobster

No fish or shellfish

SALADS *

Select items that you LIKE and place notes in the comments section.

Fresh greens/lettuces, such as Romaine, red leaf, arugula, spinach, etc.)

Fruit in your salad

Protein in your salad

Salads as a main dish

No salads

SALAD DRESSINGS *

Select items that you LIKE and place notes in the comments section.

Cashew based (creamy)

Vinaigrette (any)

Sweetened with fruit, raspberry vinaigrette, etc

No salad dressing

SOUPS/STEWS *

Select items that you LIKE and place notes in the comments section.

Cream Based

Hot

With meat/poultry

Soups/stews as main dish

No soup/stews

VEGETABLES *

Select items that you LIKE and place notes in the comments section.

Green (peas, green beans, spinach, asparagus, peppers, cabbage, pea pods, celery, brussel sprouts, mustard greens/greens, broccoli, zucchini, avocados, poblanos, okra)

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

No vegetables

GRAINS *

Select items that you LIKE and place notes in the comments section.

Rice (brown, white, wild, pilaf)

Quinoa

No grains

SEASONINGS *

Select items that you LIKE and place notes in the comments section.

Fresh herbs; oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika

Chili powder

Curry

Fresh Garlic

Pepper—white, black or red

Salt

No seasoning

EGGS *

Please select items that you LIKE and place notes in the comments section.

Whole

Yolks Only

Whites Only

No eggs

FRESH JUICES *

Please select items that you LIKE and place notes in the comments section.

Citrus

Vegetable

Blends/Cleanses

No juices

OTHER *

Please select items that you LIKE and place notes in the comments section.

Dried Fruits

Nuts (pecans, peanuts, walnuts, almonds, cashews, Brazil, etc.

None of the above

FRUITS *

Please select items that you LIKE and place notes in the comments section.

Citrus

Berries

Melons

Apples, Pears

No fruit

SPICY FOODS *

What level of spice to you prefer?

Bland

Mild

Moderate

Very Hot

No spice

Which meals would you like us to prepare for you? *

Please select all that apply.

Breakfast

Lunch

Dinner

Snacks

Dessert