Client Assessment

In order to make this a “personal” chef service, it is my passion to learn everything I can about you, my client. And, if there are more members in your household, I would love to learn about their needs as well. I take your health and lifestyle very seriously. By filling out this client assessment I will be able to customize your meal plans. Of course, I am excited as well to meet you in person during our free consultation in hopes to learn even more. Thank you for your time in filling this out.

Client Assessment

First Name(required)
Last Name(required)
Email Address(valid email required)
Street Address
City
State/Prov
Zip/Postal Code
Home Phone
Business Phone
Cell Phone
Are there other people living in your home?
Yes No
If so, how many and what are there ages?
Do you have any pets?
Yes No
If so, how many and what kind?
Please explain any medical conditions in the family that I may need to be aware of:
Are you or any member of the household sensitive to any of the following:
Are there any not mentioned?
Is anyone lactose intolerant?
Yes No
Please list any allergies in your household:
Are there any fruits or vegetables that are especially liked or disliked?
Please list favorite meals that you would like me to fix:
What are for families favorite cuisines?
Are you or anyone in your household:
How spicy do you like your food?
Very Hot Hot Medium Mild Bland
What is your family's favorite comfort food?
Do you enjoy soups?
Yes No
Do you enjoy salads?
Yes No
Do you enjoy salads?
Yes No
Please list any lettuces that you do not like:
Please list any meats you do not like:
Please list any fish you do not like:
Please list any shellfish you do not like:
Please list any starchy side dishes you do not like:
Please list any beans and/or legumes you do not like:
Please list any nuts and/or dried fruits you do not like:
Please list any cheeses you do not like:
Please list any vegetables you do not like:
List any other foods, food textures, spices, herbs, or flavors that you or your household does not like?
Do you like to eat breads or rolls with your entrees?
Yes No
Do you want me to purchase Organic Foods? (if yes, please note a possible price increase):
Yes No
If yes, which types?
May I cook with wine and/or liquors?
Yes No
Are you trying to lose weight?
Yes No
Please explain any "diet" plan you my be following:
What type of service are you interested in?
Weekly Every two weeks Monthly Occasionally
How would you like your meals packaged?
Individual For Two Family Style
What type of containers do you prefer?
Disposable Reusable High end reusable (i.e Pyrex)
Do you have a microwave?
Yes No
Is your stove gas or electric
Gas Electric
Do you prefer to heat your meals in the microwave or oven/toaster oven?
Microwave Oven/toaster oven
Do you have an extra refrigerator or freezer?
New FieldWould you sometimes like me to prepare meals that you can finish when you get home? (for the grill, fajitas, tacos, etc.)
Yes No
Do you have any special arrangements in order for me to enter your home? (alarm, keys, etc.)
Please tell me anything else that you might feel is important for me to know in order to meet your needs?
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Client Assessment

Client Assessment

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