Food Questionnaire
Please fill out the following detailed food questionnaire. After you have filled out and submitted it, we will follow up to schedule a consultation call so we can create your first menu and get your Chef services scheduled!
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Best days for Chef Brenda to cook in your home:
*
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Date you would like to start your service:
*
-
Month
-
Day
Year
Date
How many people will be eating the meals?
*
How did you hear about La Vida Culinary's chef services?
*
Google
Friend or family
Facebook
Instagram
ChatGPT/Google Gemini AI Search
Other
Food Preferences and Restrictions
Please let us know the specific foods you like, don't like, and any food restrictions or concerns you have. Once submitted, we will schedule a 15-minute consultation with you so we can provide a final quote and get you on our schedule. We look forward to cooking for you!
Please list any food allergies or food sensitivities:
Beef (check all you DO like; if you don't want any beef, please check the last box)
*
Steak - Tenderloin, NY Strip, Flank Roast
Ground Beef
Short Ribs
Stew
I do not want any beef
Lamb(check all you DO like; if you don't want any lamb, please check the last box)
*
Lamb chops
Stew
Ground lamb
Lamb roast
I do not want any lamb
Pork (check all you DO like; if you don't want any pork, please check the last box)
*
Pork chops
Pork loin
Ground pork
Cured pork
I do not want any pork
Veal (check all you DO like; if you don't want any veal, please check the last box)
*
Veal scallopini
Ground veal
Stew
I do not want any veal
Chicken (check all you DO like; if you don't want any chicken, check the last box)
*
Boneless skinless breast
Bone-in, skin-on chicken breast
Chicken thighs
Chicken legs
Dark meat
Ground chicken
I do not want any chicken
Turkey (check all you DO like; if you don't want any turkey, check the last box)
*
Ground turkey
Turkey breasts
Turkey cutlets
I do not want any turkey
Sausage (check all you DO like; if you don't want any sausage, check the last box)
*
Beef sausage
Pork sausage
Chicken sausage
Turkey sausage
I do not want any sausage
Fish (check all you DO like; if you don't want any fish, please check the last box)
*
Salmon
Tilapia
Cod
Mahi mahi
Halibut
Tuna steak
I do not want any fish
Shellfish (check all you DO like; if you don't want shellfish, check the last box).
*
Shrimp
Scallops
Crab
Clams
Calamari
Seafood mix
I do not want any shellfish
Salad - as a side dish or entree base (check all you DO like)
*
Mixed greens
Arugula
Spinach
Kale
Rice-based salad
Pasta-based salad
No salad, please
Other
Salad dressing (check all you DO like)
*
Vinaigrette - Italian, balsamic, herb, citrus
Mayo based - ranch, blue cheese, thousand island
Oil and vinegar
No salad dressing
Other
Soup - as a side dish or entree (check all you DO like) Creamed With meat or poultry Vegetable Beans - lentil, etc
*
Creamed soups
Soups with meat or poultry (based on meat preferences noted above)
Vegetable soups
Bean soups
Lentil soups
No soups, please
List any vegetables you DO NOT LIKE (such as turnips, onions, etc.)
*
Would you like to see fruit used in a dish? (ex: fruit mango salsa & apricot chicken) Please list any specific fruit likes or dislikes.
*
Grains (please check all you DO like)
*
White rice
Brown rice
Barley
Couscous
Polenta
Quinoa
Whole wheat pasta
Regular pasta
Filled pasta, such as ravioli, tortellini, lasagna
I do not want any grains
Potatoes (please check all you DO like)
*
White potato
Sweet potato
Red, purple, gold potatoes
I do not want any potatoes
Beans and legumes (please check all you DO like)
*
Black eyed-peas
Cannellini
Garbanzo beans (chickpeas)
Kidney beans
Red beans
Black beans
Lima beans
Pinto beans
Green peas
Lentils
Peanuts
I do not want any beans or legumes
List any herbs you do NOT like (basil, rosemary, mint etc.)
*
List any spices you do NOT like (cumin, curry, ginger powder etc.)
*
Seasoning and spice level (please choose your preference)
*
Bland
Mild/medium
Well-seasoned
Spicy
Dairy (check all you DO like; if you don't want any dairy, please check the last box)
*
Milk
Yogurt
Cream cheese
Sour cream
Heavy cream
Asiago CheeseCheddar Feta Ricotta Goat Cheese Gorgonzola Mozzarella
Cheddar Cheese
Mozzarella
Ricotta
Swiss
Gorgonzola
Goat cheese
I do not want any dairy products
Dairy Alternatives (check all you DO like; if you don't want any non-dairy products, please check the last box)
*
Almond milk
Oat milk
Soy milk
Cashew milk
Coconut milk
Dairy-free cheese
Dairy-free yogurt
Dairy-free cream
I do not want any dairy alternative/non-dairy products used
Eggs: ok to use in cooking?
*
Yes
No
Would you like any dishes that use tofu?
*
Yes
No
Nuts & Seeds: List any you love (almonds, cashews, pecans, pine nuts, etc.)
*
Miscellaneous (please check all you DO like)
Black olives
Green olives
Kalamata olives
Capers
Artichoke Hearts
Jalapenos
Ethnic Cuisines (please check any you LOVE)
Italian
Mexican
Greek
Japanese
Chinese
Indian
Korean
Thai
Kosher
Jewish
Other
Favorite Restaurants: List your top 3 favorite restaurants
Specific health goals/concerns (examples - weight loss, gluten-free, health food at home)
List any foods or dishes you LOVE
*
List any foods you REALLY DISLIKE
*
How involved do you want to be in meal preparation?
*
Very little (I prefer meals I just have to heat and eat)
Some (I will sautee vegetables and put food in the oven to cook)
Moderate (I want prepped food, but I will cook it)
How do you want your meals packaged?
*
Individual
Family style
Do you already own containers for us to package your food in ?
*
Yes
No
Do you prefer glass or plastic containers?
*
I prefer glass containers
I prefer plastic containers
List your 3 favorite places to food shop:
YOUR KITCHEN SUPPLIES: Since Chef will be cooking in your home, we need to know what kitchen supplies you have. Please check all that you DO have:
*
A basic set of pots and pans
A cutting board
Sheet pans
Mixing bowls
Aluminum foil
Parchment paper
Ziploc bags
Basic spices (salt, pepper)
Olive oil
All of the above and more
Very little (not even the basics)
Strainer
Mixer/blender/food processer
Do you use any specific cleaning products or procedures for specialty appliances that we need to know about?
What is your main reason for using our personal chef services?
Are you in agreement with our company policy that Bback4More LLC (DBA La Vida Culinary) is not responsible for scratches to any appliances and that cooking in your home will result in normal wear and tear to your kitchen and appliances?
*
Yes
No
Anything else related to food / lifestyle you would like us to know?
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