Vacation Stay Client Assessment

Chef Aline Steiner


Contact Information



Vacation Dates & Information



Please Select Desired Meals


Breakfast

Breakfast on All Days?YesNo
Would you like Breakfast?YesNo
Requested Breakfast Dates

Lunch

Lunch on All Days?YesNo
Would you like Lunch?YesNo
Requested Lunch Dates

Dinner

Dinner on All Days?YesNo
Would you like Dinner?YesNo
Requested Dinner Dates


What time would you like your meals served?


Breakfast
Lunch
Dinner



Any Birthdays while on vacation?



General Questions pertaining to your health and food habits

Is anyone diabetic, hypoglycemic/Hyperglycemic, has high blood pressure or high cholesterol?
YesNo

Does Anyone have any other medical condition or situations that need to be taken in consideration in menu planning; eg; pregnancy or restricted diet?
YesNo

Are there any known food allergies, food intolerance or sensitivity?
NoneWheatGlutenNutsShellfishLactoseother

Is Anyone Vegetarian?
YesNo

Please specify name and type below
Pescatarian (no meats but will eat fish)Flexitarian/Semi-Vegetarian (mostly vegetarian but occasional meat)Lacto-Ovo-Vegetarian (no meat, fish or shellfish but will eat dairy and eggs)Lacto-Vegetarian (no meat, shellfish, fish or eggs but will eat dairy)Ovo-Vegetarian (no meat, shellfish, fish or dairy but will eat eggs

Any other special diet? ei: low fat, low carb, etc.?

Do you prefer fine Dining or everyday, homestyle food?
Fine DiningHomestyle CookingBoth

What foods does your party most dislike?

Any dislikes in herbs or spices ei; cilantro, curry, pepper etc....

Any dislikes in staples ingredients ei; onions, garlic, sesame etc....

May I use wines or liquor in the preparation of certain dishes?
YesNo

Do you generally prefer organic produce, dairy or meats when available or regular?
YesNo

What are some staples you like, or favorites foods?

Would you enjoy pre-dinner appetizers or hors d’oeuvres
served at cocktail hour?

YesNo

Please check the types of cuisines you enjoy
ItalianFrenchMediterraneanScandinavianGreekChineseJapaneseThaiIndianAmericanMexicanFusionAllOther

.


How Many times a week do you enjoy the following?


Please choose all types of meats and poultry that you enjoy
BeefVealLambBisonPorkChickenTurkeyDuckVenisonGooseSpecialty such as Foie GrasOther

Meat doneness preferences when applicable
RareMedium RareMediumDoneWell Done

Please choose all types of fish that you enjoy

Local Seasonal Fish

Ahi TunaButterfish (cod)Mahi-MahiOnaga (red Snapper)Ono (wahoo)Opah (moonfish)Opakapaka (hawaiian snapper)

Please choose all types of Shellfish that you enjoy
ShrimpsPrawnsScallopsMusselsClamsOystersCrabLobsterSpecialty such as Caviar

Do you Enjoy Spicy foods?
YesNo
No SpiceMildMediumHotVery HotHurting Hot

Dairy products preferences
Fat FreeSkim1%2%Whole MilkLactose freeSoy MilkAlmond MilkRice Milk




Children's Corner

If Children are in your group please check the following;

Would the children enjoy the same meal and dinner time as the adults?
YesNo

If NO please indicate the children meals time

Would you prefer separate simplified Children menus?
YesNo

Please indicate favorites or any other requests for the children




Additional Notes