Personal Chef Service Intake Form Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country List any health concerns/medical issues * List any food allergies and/or sensitivities * Are you currently following a diet plan? Check all that apply * Gluten-Free Grain-Free Egg-Free Dairy-Free Sugar-Free Paleo Raw Vegan Vegetarian Pescatarian Keto low-FODMAP Other What are you hoping to accomplish with this service? How are you hoping to feel? * Please list some examples of what you typically enjoy eating for breakfast, lunch, dinner, dessert, and snacks. * Please list your favourite cuisines List any foods that you dislike or refrain from eating for reasons other than allergies. Do you have a preference on where to shop for your ingredients? Which days of the week would be best for in-home cooking? * Number of people * Number of recipes per week (each recipe is 2-3 portions) * How long would you like to sign up for? * whether it's 2 weeks or 6 months, we are happy to help! Just want to try it for a week 1 month 2-3 months 3 months + Any additional notes or anything we missed? Thank you!
