Client Intake/Food Questionnaire
Tell us about yourself and your food preferences below.
Email
example@example.com
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Primary Phone Number
Please enter a valid phone number.
How did you hear about us?
CNK Website
Google
Facebook
Instagram
Yelp
Vendor Referral
Client Referral
Other
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
City
State / Province
Postal / Zip Code
Property Type
Please Select
Apartment
Condominium
House
Access Notes
How hungry are you?
When would you like to start service?
-
Month
-
Day
Year
Date
How often do you want us to deliver meals?
Weekly
Every Two Weeks
Monthly
Do you have a need for delivery to be on a certain day of the week? If so, which day?
Sunday
Monday
Tuesday
Wednesday
Thursday
How many days will you eat prepared food?
Which meals can we prepare?
Breakfast
Lunch
Dinner
Dessert
Snacks
How many sides would you like?
1
2
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
Please Select
Individual
Family
Couple
If a family, how many other people are we cooking for?
Let's Talk About Food!
Check the following dietary restriction you require
Gluten-Free
Paleo
Vegetarian
Vegan
Keto
None
Other (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?
Please Select
Rare
Medium rare
Medium
Done
Well done
Submit
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