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Primal Chef Dietary Intake
The purpose of this form is to gather as much information as possible at one time to ensure appropriate meals are prepared. Please be as thorough as possible when completing this form
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Your Name
*
Your answer
In general, what diet do you follow?
Paleo
Keto
Bulletproof
Auto-Immune Protocol (AIP)
Carnivore
Vegetarian
Vegan
Pescetarian
Low fat / low calorie
No strict diet, just prefer overall healthy food
Anything goes!
Other:
Please list ALL dietary restrictions, intolerances, and allergies
*
Your answer
In general, describe the way you like to eat
Your answer
Describe your preferred average breakfast
Your answer
Describe your preferred average lunch
Your answer
Describe your preferred average dinner
Your answer
Describe your preferred average snacks
Your answer
Describe your preferred desserts
Your answer
Are you open to trying new foods and trusting the chef to make it taste good?
Yes
No
Other:
Clear selection
Please indicate which ingredients you WILL eat
Peanuts
Cashews
Legumes, beans, lentils
Fish sauce (key seasoning used in most Vietnamese and Thai dishes)
Vinegars
Coconut aminos
Soy Sauce (Regular)
Soy Sauce (Gluten free Tamari)
Sesame oil, seeds, tahini
Miso (soy)
Miso (chickpea)
Wine (red, white, sake, mirin, etc - alcohol cooked off)
Chili oil (nightshade)
Hot sauces (nightshade)
Mayonnaise (avocado-oil)
Mustard
Ketchup
Honey
Maple syrup
Coconut sugar
Sugar alcohols (Swerve, stevia, Xylitol, Monk fruit, erythritol, etc)
Tapioca & Cassava starch / flour
Almond flour / milk / butter / other almond products
Coconut flour / milk / butter / other coconut products
White rice / rice noodles / rice flour
Gluten-free grains (brown rice, millet, quinoa, buckwheat, corn, etc)
Garlic, onions, shallots
Salt
Black pepper
Other:
Do you like your steaks, burgers, chops, roasts, etc cooked to
Rare
Medium rare
Medium
Medium well
Well done
Other:
Clear selection
Do you eat dairy?
Butter
Cream
Cheese
Milk
None
Other:
Do you typically eat
Heavy
Moderate
Light
Other:
Clear selection
Do you like spicy food?
No
Mild
Medium
Hot
Other:
Clear selection
Do you eat nightshade vegetables?
None
Bell peppers
Hot peppers
Tomatoes
White potatoes
Eggplant
Other:
What are your favorite foods or ingredients?
Your answer
What are your LEAST favorite foods or ingredients? Also mention if there are any foods you absolutely will NOT eat
Your answer
What style of food is preferred?
Fine dining (Plated)
Casual (Family style)
Street food
Other:
What are your favorite cuisines?
American
British
Canadian
South American
Thai
Vietnamese
Chinese
Japanese
Korean
Indian
Middle eastern / Mediterranean
Italian
Mexican
Cuban
Peruvian
Argentinian
French
Cajun / Creole / New Orleans
Other:
We typically shop at Whole Foods. When available, do you prefer
All organic produce, 100% grass-fed meat, pastured pork, chicken, eggs, wild fish, REGARDLESS OF PRICE (if available)
Balance of cost, quality, sourcing, and availability (Maybe not 100% organic / grass-fed meat but still Whole Foods quality)
Other:
Clear selection
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