Vacation Stay Client Assessment

Chef Aline Steiner

Contact Information

Vacation Dates & Information

Please Select Desired Meals


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


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


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

What time would you like your meals served?


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?

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

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

Is Anyone Vegetarian?

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?

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

What are some staples you like, or favorites foods?

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


Please check the types of cuisines you enjoy


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?
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?

If NO please indicate the children meals time

Would you prefer separate simplified Children menus?

Please indicate favorites or any other requests for the children

Additional Notes