“I did not think anyone would be able to give me so much variety and make everything taste so good with such limited ingredients….due to my SEVERE food allergies.”

April F. – allergic to wheat, gluten, soy, dairy, eggs, chicken and beef, with Candida issues

Food Questionnaire

Fill out our food questionnaire to get started with a customized meal delivery service!

Your First Name * Your Last Name * Other Adults (Names) Children (Names and Ages) Address City State Zip Code Preferred Contact Number * What day and time is best to reach you by phone? * Preferred Email Address * How did you hear about Savor? * If you Googled us, what were the keywords you used? Please check the boxes of the items that you like only and place notes in the comment section. MEATS Beef (steak/roasts/ground round) Steak cooked Pork (chops/roasts/ribs/bacon/ham/ground) Lamb (chops/stew/ground/roasts) Meatloaf Bison Comments (Meats) POULTRY: Chicken (breasts/thighs/ground, etc.) White Meat Dark Meat Mixed Turkey (breasts/smoked/ground, etc.) Chicken or turkey meatloaf Comments (Poultry) FISH/SHELLFISH Fish (bass, yellowtail, halibut, salmon, snapper, etc.) Shrimp Scallops Crab Lobster Comments (Fish/Shellfish) SALADS Fresh Green (choice of greens/lettuces, such as Romaine, red leaf, bibb, mixture, spinach, etc.) Fruit in your salad Salads as a main dish Comments (Salads) SALAD DRESSINGS (List other salad dressings in the comments) Ranch Vinaigrette (any) Comments (Salad Dressing) SOUPS/STEWS Creamed If you checked creamed, name type(s) With meat/poultry? Soups/Stews as a main dish? Comments (Soups/Stews) VEGETABLES (List vegetables you will not eat in the comments) 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, carrots) White (cauliflower, potatoes, parsnips, water chestnuts, bamboo shoots, bean sprouts, onions, mushrooms, leeks) Beans (black, ranch-style, pinto, kidney, lima, white, pink, black-eyed peas, split peas) Capers, black olives, green olives, coconut, artichokes, eggplant Comments (Vegetables) GRAINS Rice (brown, white, wild, pilaf) Couscous Quinoa Farro BREADS Cornbread Muffins Pancakes / Waffles Tortillas (corn, white or wheat) Comments (Grains and Breads) SEASONINGS (List seasonings you will not eat in the comments) Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, celery, chili powder, curry Fresh garlic, parsley Pepper – white, black or red Salt – Kosher (food is prepared very low in salt so that you may season to taste) Comments (Seasonings) FATS/OILS Butter Olive Oil and other healthy oils (sesame, walnut, pecan, avocado, truffle, etc.) Comments (Fats/Oils) Is it okay to cook with wine? * Yes No

MILK AND MILK PRODUCTS

(List any cheeses you do not like in the comments)

Cheeses (parmesan, cheddar, Swiss, muenster, fontina, blue, feta and goat etc.) Milk (skim, 1%, 2%, whole) Yogurt Sour Cream Comments (Milk Products) EGGS Whole Yolks Only OTHER Dried Fruits Nuts (pecans, peanuts, walnuts, almonds, cashews, Brazil, etc.) Pizza Comments (Eggs and Other) Fruits disliked List any known food allergies Spicy foods – bland/mild/moderate/very hot Do you have any favorite recipes that I can prepare for you? Cuisines liked (Mexican/Curries/Italian, Home-style) Favorite food/restaurants Which meals (Breakfast, Lunch, Dinner, Snacks and Dessert) Number days a week you/family will eat prepared food Number of servings for each meal Portion Control (Yes or No) Service Frequency (weekly, bi weekly, bi monthly, monthly) Sides with service (1 side with each entree or 2 with each entree Organic or Non-organic groceries Comments / Questions Enter your initials to complete your questionnaire *

Have any questions or concerns? Feel free to leave any questions you don’t know the answer to blank or give us a call. We look forward to setting up your meal delivery service that fits best with your lifestyle and dietary needs and preferences!

Savor Culinary Services

800 W. 5th St.
Fort Worth, TX 76102 Phone: 817-277-3031
Email: [email protected]