Current Food Preferences

Serving Healthy can work with you to design recipes and meal plans that are healthy and based on items that you enjoy eating, but first it is important to understand your current food behaviors. Accurately answering the questions below will provide a good start to designing an enjoyable nutrition plan. When you have finished answering the questions, please submit your answers by entering the validation code at the bottom of this page and clicking the Submit button. All of the information is strictly confidential between you and your Serving Healthy counselor and will not be shared or distributed.

Food Preferences:
During a typical week, how many days do you eat breakfast?
During a typical week, how many days do you eat lunch?
During a typical week, how many days do you stop your normal activities and take a break to sit down and eat lunch?
During a typical week, how many days do you eat dinner?
During a typical week, how many days do you watch television or work while you are eating dinner?
What four foods do you eat most often? (Examples: Eggs, Oatmeal, Salad, Soup, Deli Sandwiches, Hamburgers, Chicken, Fish, Legumes, Steak, Tofu, etc.)
What are your four favorite foods? (Examples: Popcorn, Pizza, Hamburgers, Pasta, Cheese, Salad, Steak, Sushi, Bacon, Chinese Food, Ice Cream, etc.)
What three foods do you dislike the most or refuse to eat? (Examples: Bell Peppers, Beets, Brussles Sprouts, Cabbage, Beans, Cilantro, Rosemary, Thyme, etc.)
What ethnic foods do you enjoy? Check all that apply.
 Chinese  Mexican  Italian
 Thai  Indian  Greek/Mediterranean
 French  Japanese  Spanish
How many times per month do you eat your meals at a restaurant?

What are the three most common types of restaurants at which you eat? (Examples: Fast Food, Italian, Deli, Barbeque, Soup/Salad, Mexican, Indian, etc.)
What are your three favorite protein foods? (Examples: Beef, Chicken, Seafood, Beans/Lentils, Tofu/Tempeh, Seeds/Nuts/Quinoa, etc.)
How many times per week do you eat vegetable based proteins? (Examples: Beans/Lentils, Soy/Tofu/Tempeh, Seeds/Nuts/Quinoa, etc.)
How many times per week do you eat meat/animal protein? (Examples: Beef, Bison, Chicken, Fish, Eggs, Cheese, Milk, Deli Meats, etc.)
What are your 3 favorite vegetables, not including salad?
How many times per week do you eat vegetables?
How many times per week do you eat a salad?
How often do you snack between meals, including candy, chocolate, fruit, chips, etc.?
List three typical snacks you eat during the week
Do you like hot peppers and spicy food?
On average, how many times per week do you eat fried foods? (Examples: Doughnuts, French Fries, Onion Rings, Egg Rolls, Corn Dogs, Fried Chicken/Fish, etc.)
Do you try to choose whole grains over processed grains? (Examples: Oatmeal instead of boxed cereal, brown rice or quinoa instead of white rice, whole wheat bread/buns)
On average, how many times per week do you eat nuts or seeds? (Examples: Peanuts, Cashews, Almonds, Pistachios, Sunflower Seeds, etc.)
On average, how many times per week do you eat dairy products? (Examples: Non-fat milk, low fat milk, whole milk, cheese, yogurt, butter, etc.)
What beverages do you typically drink? Check all that apply.
 Water  Regular Soda  Diet Soda
 Black or Green Tea  Herbal Tea
 Dairy Milk  Non-Dairy Milk
 Coffee  Energy Drinks
What do you typically use to sweeten food and drinks? Check all that apply.
 White/Refined Sugar
 Raw/Unrefined Sugar
 Natural Sweetener (Maple Syrup, Honey, Agave...)
 Artificial Sweetener (Stevia, Sucralose, Aspartame...)
 I do not use sweeteners
How often do you drink alcohol?
Please list any dietary restrictions that you follow. (Examples: Kosher, low sodium, low saturated fat, gluten free, low carbohydrate, strict vegan, etc.)
Please list any known food allergies.
How would you classify your interest in food? Check all that apply.
 I frequently watch food shows on television.
 I am always trying new and different food.
 I often search the Internet for recipes.
 I occasionally try new things.
 For the most part, I only like what I grew up eating.
 I like to have someone else decide what to eat.
 I eat whatever is convenient.
 I eat only for survival.
How would you classify your abilities in the kitchen? Check all that apply.
 My friends really like what I cook, so I must be good!
 I own more than one knife, and I use them frequently.
 I own a full set of pots and pans, and use them more than 3 times per week.
 I use the microwave more than I use the stove or oven.
 I only know how to make a few dishes.
 I don’t like cooking, but I do it because it is necessary.
 I wish someone would cook for me.
 I don’t know anything about cooking.
Contact Information:
*First Name:
*Last Name:
Email Address:
Phone Number:
Please select a contact method:
 E-Mail    Telephone
 Please do not contact me.
Preferred contact days and times:
Additional comments or questions:

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