Wufoo

Culinary Services & Food Profile

This form is for those interested in culinary services, meal planning, and cooking classes. Please fill in the sections that apply to you.

Date MM / DD / YYYY
Name * First Last
Gender *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone ### - ### - ####
Cell Phone * ### - ### - ####
Email *
Best way to Communicate *
Height
Current Weight
Are you
Pregnant Recently postpartum Trying to get pregnant
Food Preferences-Dietary Information
Food likes/favorites
Food Dislikes/aversions
Any particular cravings?
What do you normally eat for breakfast?
Lunch?
Dinner?
What about snack foods?
Any food allergies or sensitivities?
Please explain any health concerns I should be aware of

i.e. high blood pressure, high cholesterol, cancer, diabetes,
Dietary Observances and Restrictions
Diabetic Vegetarian/ Vegan/ Raw Gluten free Low sodium Low Fat
What change(s) are you looking to make?
Improve eating habits Learning to manage your weight Learning cooking techniques
Green Cuisine: Cooking Service Information
Meal Prep days
How often do you want service?
Number cooking for
Number of servings
Any budget for food
Type of service
Regular Custom menus Specialized menus
Specialized Menus
Diabetic/low sugar VegetarianVegan/Raw Foods Gluten Free Baby Foods Children's Meals Expecting mother/Breastfeeding Low carb Low Fat
What type of storage for food?
Cooking Class Information

Get ready to bang some pots and pans!
Class Theme?
Length of class
Number of Participants
Age range of participants
How many classes?
One class Ongoing classes
If ongoing, how fequent?
What time of day works best for you?
Where will the class(es) be conducted?
Please provide address where class(es) will take place if different from your residence
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Kitchen Equipment/Appliance Inventory

Please check off the items you have in your kitchen. This gives me a sense of what we have to work with.
Knives
French 8" French 10" Japanese 8"
Processors
Food Processor Hand Mixer High Speed Blender Spice Grinder
Pots & Pans
Pan, frying Pan, sauteing Pot, 2-3 QT Pot, 6-8 QT Pot, 8-12 QT
Baking
Baking Sheets Glass/ceramic dishes, large Glass/ceramic dishes, small Dutch Oven
Basic Equipment
Cutting Boards Spatulas Wooden Spoons Mixing Bowls Colander Grater Kitchen Towels
Do Not Fill This Out

Wufoo

Culinary Services & Food Profile

Food Preferences-Dietary Information

Green Cuisine: Cooking Service Information

Cooking Class Information

Kitchen Equipment/Appliance Inventory