Food Preferences Questionnaire

• Please check off all foods that you eat, or are willing to try.

Allergies or Food Intolerances

MILK PRODUCTS
GRAIN PRODUCTS CONDIMENTS
Fluid Milk  Mayonnaise
Cereals  Skim  Ketchup
 Oatmeal/Hot Cereal  1%  Mustard ___________
 Cereals - brands?  2%  BBQ/Steak Sauce
_________________  Soy  Hummus
Breads  Rice Milk  Salsa
 Bread ___________  Almond
 Pita Bread DRINKS
Cheese
 Buns/Baguettes  Juice ______________
 Cheddar
 Bagels
 Mozzarella  Coffee: type, what do
 Wraps
 Feta
you put in it?
Side Grains  Blue
 Pasta  Cottage
 Rice  Goat  Tea: type, what do you
 Other ___________  Other ___________
put in it?
Crackers Cultured Milk Products
 Crackers _________  Yogurt
 Alcohol: average per
 Ry Vita, Wasa, etc  Sour Cream
week?
 Rice crackers  Other ___________
 Other ___________
MEAT & ALTERNATIVES  Other _____________
Bars
 Granola Bars
Meat COOKING HABITS
 Protein/Energy Bars
 Beef: steak
 Other ___________
 Beef; ground How much time do you spend
Do you eat spreads?  Pork: chops, preparing meals?
 Nut Butter tenderloin
 Peanut Butter  Chicken; Breast
 Jam  Chicken; ground Do you have one major cooking
 Margarine  Turkey: Breast day each week, e.g. Sunday?
 Butter  Turkey; ground
 Cream Cheese  Veal
 Lamb Do you have a favorite meal,
FRUIT & VEGETABLE  Bison that you eat each week, e.g.
 Other _____________ pizza every Friday?
Are there any fruit and/or
Processed Meats
vegetables that you don’t like?
 Lunchmeats
 Sausage Do you use a:
 Bacon  BBQ
 Other _____________  Wok
What are your favorite fruits and  Microwave
vegetables? Fish  Toaster oven
 Salmon  Oven/Stove Top
 Halibut
 Shrimp Are there any sauces or spices
Do you eat potatoes?  Canned Tuna that you really don’t like?
 Other _____________
Do you eat avocado?
Egg Products
 Whole egg Ethnic Tastes
Do you eat salad?  Mexican
 Liquid Egg
 Egg whites only  Asian
Salad Dressings  Indian (curries)
 Oil & Vinegar Vegetarian Proteins  Hot/Spicy
 Caesar  Tofu  Other _____________
 Italian  Soy-based meat alt.
 Other ___________  Beans/legumes Favorite desserts and sweets?
 Nuts