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