Inpatient Retreat Food Preferences
Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Do you have any special dietary requirements? (e.g. vegan, gluten free etc)
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Do you have any known food intolerances or allergies? Please provide a brief description of each, including the severity.
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Are there any ingredients you dislike or avoid?
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Are there any ingredients that you enjoy and would like to eat more of?
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How do you feel about chickpeas, lentils, legumes - do you experience discomfort with any of these? (e.g. bloating, wind, etc)
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Do you enjoy plant based proteins such as tofu and tempeh?
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Our usual meal times are: Breakfast 8am, Lunch 1pm, Dinner 7pm. Is there anything unique about your eating schedule that may affect these times? (e.g. You fast in the morning or prefer early dinners, etc).
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DAIRY ALTERNATIVES - Please select the dairy alternative you prefer or would like to try:
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Coconut
Almond
Soy
Oat
Macadamia
Other
Please provide any additional notes about your food and eating preferences that we need to know. Our Wellness Chef Amy will do her best to accommodate.
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