Client Intake/Food Questionnaire

Client Intake/Food Questionnaire

Tell us about yourself and your food preferences below.
Email
example@example.com
Date

MonthDayYear
Date
Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.
How did you hear about us?

CNK WebsiteGoogleFacebookInstagramYelpVendor ReferralClient ReferralOther
Additional Contact Name
Additional Contact Phone
Please enter a valid phone number.
Additional Contact Email
example@example.com
Where will we be delivering?
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Type
Access Notes
How hungry are you?
When would you like to start service?

MonthDayYear
Date
How often do you want us to deliver meals?

WeeklyEvery Two WeeksMonthly
Do you have a need for delivery to be on a certain day of the week? If so, which day?

SundayMondayTuesdayWednesdayThursday
How many days will you eat prepared food?
Which meals can we prepare?

BreakfastLunchDinnerDessertSnacks
How many sides would you like?

12
How would you like your meals to be packaged?

Family Style (each component individually)Individually (each meal individually)
Who else is eating with you?
Client Type
If a family, how many other people are we cooking for?
Let's Talk About Food!
Check the following dietary restriction you require

Gluten-FreePaleoVegetarianVeganKetoNoneOther (leave other details below)
Please elaborate on your dietary restrictions, preferences, etc.
Please list any known food allergies, including those that cause anaphylaxis.
This one is pretty important due to cross-contamination!
Please list any food sensitivities, and how strict you are about avoiding them.
i.e. I have a dairy sensitivity, but butter and ghee are okay!
Do you have any strong dislikes?
Beets? Cilantro? Mushrooms? Olives? Lamb? Shrimp? Eggplant? Fennel?
Which proteins do you eat?
Chicken, turkey, duck, beef, pork, lamb, fish, shellfish? Tofu, tempeh, beans and lentils? Eggs?
How do you prefer your red meat cooked?
Should be Empty:

Client Intake/Food Questionnaire

Where will we be delivering?

How hungry are you?

Who else is eating with you?

Let's Talk About Food!