Food Questionnaire

Food Questionnaire

Fill out our food questionnaire to get started with a customized meal delivery service! After receiving your completed questionnaire, we will contact you to schedule a phone conversation where we can review your responses together and address any concerns.
Have any questions or concerns about our services or filling out the food questionnaire? Feel free to give us a call at (607) 229-2214. We look forward to setting up your meal delivery service that fits with your lifestyle, dietary needs, and preferences.
Name*

First NameLast Name
Email*
example@example.com
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Other Adults (Names)

First NameLast Name
Children (Names & Ages)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What day & time is best to reach you by phone?
How did you hear about Ba-Li Cravings?*
If "Other" please specify:
If "referred", please let us know who we can thank for the referral.
Include their name, email or phone number
If you Googled us, what were the keywords you used?
How will this service best help improve your life such as improve your health, save time, want freshly made nutritious food for me and my family, more family time, make healthier choices, lose weight, etc.?
What is your preferred delivery day? *
MEATS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Beef (steak/roasts/ground round) Steak cookedPork (chops/roasts/ribs/bacon/ham/ground)Lamb (chops/stew/ground/roasts)MeatloafBisonWe/I will eat all of the above
Comments (Meats)
POULTRY Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Chicken: White Meat (breasts/thighs/ground, etc)Chicken: Dark Meat (breasts/thighs/ground, etc)Chicken: Mixed (breasts/thighs/ground, etc)Turkey (breasts/thighs/ground, etc)Chicken or turkey meatloafWe/I will eat all of the above
Comments (Poultry)
FISH/SHELLFISH Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Fish (bass, yellowtail, halibut, salmon, snapper, etc.)ShrimpScallopsCrabLobsterWe/I will eat all of the above
Comments (Fish/Shellfish)
SALADS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Fresh Green (choice of greens/lettuces, such as Romaine, red leaf, bibb, mixture, spinach, etc.)Fruit in your saladSalads as a main dishWe/I will eat all of the above
Comments (Salads)
SALAD DRESSINGS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

RanchVinaigrette (any)Other (list in comments)We/I will eat all of the above
Comments (Salad Dressing)
SOUPS/STEWS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Creamed (list types in comments)With meat/poultrySoups/stews as a main dishWe/I will eat all of the above
Comments (Soups/Stews)
VEGETABLES Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Green (peas, green beans, spinach, asparagus, peppers, cabbage, pea pods, celery, brussel sprouts, mustard greens/greens, broccoli, zucchini, avocadoes, poblanos, okra, kale, swiss chard)Yellow (corn, wax beans, squash, peppers)Red (pimento, red cabbage, beets, tomatoes, peppers, sweet potatoes/yams, butternut squash, acorn squash, carrots)White (cauliflower, potatoes, parsnips, water chestnuts, bamboo shoots, bean sprouts, onions, mushrooms, leeks)We/I will eat all of the above
Comments (List vegetables you will NOT eat)
GRAINS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Rice (brown, white, wild, pilaf)CouscousQuinoaFarroWe/I will eat all of the above
BREADS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

CornbreadMuffinsPancakes/WafflesTortillas (corn, white or wheat)We/I will eat all of the above
Comments (Grains & Breads)
PASTAS Please mark your preference, and place notes in the comment section.*

We like it weeklyWe love pastaWe prefer Gluten Free pastaWe don't like pasta
Comments (Pastas)
SEASONINGS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, celery, chili powder, curryFresh garlic, parsley, cilantroPepper - white, black or redSalt - Kosher (food is prepared very low in salt so that you may season to taste)We/I will eat all of the above
Comments (List seasonings you will NOT eat/INTOLERANT to)
FATS/OILS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

ButterOlive Oil and other healthy oils (sesame, walnut, pecan, avocado, truffle, etc.)We/I will eat all of the above
Is it okay to cook with wine?*

YesNo
Comments (Fats/Oils)
MILK & MILK PRODUCTS Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Cheeses (parmesan, cheddar, Swiss, muenster, fontina, blue, feta and goat etc.)Milk (skim, 1%, 2%, whole)YogurtSour creamWe/I will eat all of the above
Comments (List cheeses you will NOT eat/INTOLERANT to)
EGGS*

WholeWhites Only
OTHER Please check the boxes of the items that you DO NOT like/INTOLERANT to only, and place notes in the comment sections.*

Dried fruitsNuts (pecans, peanuts, walnuts, almonds, cashews, Brazil, etc.)PizzaWe/I will eat all of the above
Fruit Dislikes
List Known Food Allergies*
Spicy Foods*

BlandMildModerateVery Hot
Do you have any favorite recipes?
Favorite Food & Restaurants
Tells us about your favorite meal
Which meals?*

BreakfastLunchDinnerSnacksDessert
How many days a week you/family will eat prepared food?*
Number of servings for each meal?*
Portion Control*

YesNo
Service Frequency*

WeeklyBi-WeeklyBi-MonthlyMonthly
What is your preferred method for heating food?*

OvenStoveAir fryerMicrowave
Organic or non-organic groceries?*

Doesn't have to be organicPrefer organic, when possibleAll organic is important to me
What should we know about you/your family?
Enter your initials to complete your questionnaire:
Should be Empty: