The Winning Recipe Curated Menu Experience Intake Form

The Winning Recipe Curated Menu Experience Intake Form

Thank you for choosing "TWR" to partner with you in reaching your health goals! Please fill out the form below to help us tailor your experience and meet your specific food needs.
First Name*

PrefixFirst NameLast NameSuffix
Contact Number*
Email Address*
example@example.com
In what area are you located?
What's the BEST way to reach you?*

PhoneEmailEither is fine
If contacting by phone, what's the BEST timeframe to call?*

9-11am12-1pm6-8pmOther
How many persons are you completing the form for?*

12More than 2
Would you like meals or juices?

Meals onlyJuices onlyBOTH
FOR PERSON 1: Select THREE (3) of the types of meals you would prefer:*

High protein (meat)High protein (no meat)Raw VeganGLP-1Low carbWeight lossWFPBAnti-inflammatoryImmune-boostingDairy freeDiabetic friendlyGluten freePescatarianNo nutsPaleoNo shellfishEgg freeMediterraneanSeafood ONLYOther
FOR PERSON 1: Do you have preferred proteins?*

ChickenTurkeyVeggieSalmonShrimpTofuBeefBean SourcesLambScallopsLobsterRock FishSea BassCodHalibutTroutBisonTempehOther
FOR PERSON 2: Select THREE (3) of the types of meals you would prefer:

High protein (meat)High protein (no meat)Raw VeganGLP-1Low carbWeight lossWFPBAnti-inflammatoryImmune-boostingDairy freeDiabetic friendlyGluten freePescatarianNo nutsPaleoNo shellfishEgg freeMediterraneanSeafood ONLYOther
FOR PERSON 2: Do you have preferred proteins?

ChickenTurkeyVeggieSalmonShrimpTofuBeefBean SourcesLambScallopsLobsterRock FishSea BassCodHalibutTroutBisonTempehOther
Does PERSON 1 have any food ALLERGIES?

YesNoNot Sure
Please list them.*
Does PERSON 2 have any food ALLERGIES?

YesNoNot Sure
Please list them.*
Is PERSON 1 currently taking prescribed medication? (to ensure no ingredient conflicts)

YesNo
Please list them.
Is PERSON 2 currently taking prescribed medication? (to ensure no ingredient conflicts)

YesNo
Please list them.
What type of juices would you like?

Diabetic-friendlyDetoxWeight LossEnergy BoostImmune SupportAnti-InflammatorySkin HealthIron Support / AnemiaGeneral WellnessPostpartum Recovery SupportGut Support (reset, bloating relief)Menopause SupportHormonal Balance / PMS SupportPerimenopauseJuice variety
How many juices would you like?

3-57 pack12 packOther
What is your current food need?

3 meals only5 meals only3 meals & 3 juices5 meals & 5 juicesFamily/Bulk MealsIn-Home Cooking ServicesCatering
Are you interested in the In-Home Private Chef service?*

YesNoConsidering it for the futureNot sure — please tell me more
✔ 2. Where will the private chef service take place?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What kitchen appliances do you have available?

StoveOvenAir fryerBlenderMixerColanderSmall Stovetop pansLarge potsCutting boardsSheet pansCasserole DishMixing bowls & SpoonsCooking UtencilsFood Storage ContainersOther
Preferred day/time for in-home service:
In-home cooking availability is limited. All bookings are based on schedule approval.
Will the kitchen be cleaned and ready upon arrival?

YesYes, but I may need remindersNot sure — please advise me
How soon would you like to receive your custom items?

Next meal cycle (Tuesday)2 weeks1 monthBeyond 1 month (advance conversation)
Please share person's name if you were referred.
Should be Empty: