Food & Cooking Assessment

Your Food & Cooking Interests Assessment Form
Tell us about the food, drinks and cooking skills that you use. This will help us understand better, and help you achieve your goals.
Your full name (Client)*
How do you feel about your cooking skills?*
- Never cooked
- Learning to cook
- I can cook basic meals
- I have been cooking meals for many years
If you can cook, what meals have you been cooking?*

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Tell me what foods you LIKE eating?*
Examples: meats, seafood, vegetables, fruits, salads, spices, herbs and oils
Tell me what drinks you LIKE?*
Examples: water, coffee or tea, fruit juices, soft drinks, energy drinks etc.

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FOOD SAFETY
This is very important that you tell us if you have any allergies or intolerances to food.
Do you have any FOOD ALLERGIES? Some common food allergies include peanuts, tree nuts, eggs, shellfish, sesame seeds. Please list all food allergies you have or type None:*
Do you have any FOOD INTOLERANCES? Some common intolerances include dairy, lactose, gluten, caffeine, sulphites. Please list all food intolerances you have or type None:*
Do you have FOOD PREFERENCES? These may include religious preferences. Some diets that cater to food preferences include vegan, vegetarian, pescatarian, kosher, halal, paleo. Please list your food preferences (both what you prefer to include and what you prefer to exclude) or type None:*

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Tell us the goals that you want to achieve from your program
This will help us plan your program. Examples: 1. lose weight 2. make healthier dishes 3. improve health issues etc.
Are you taking medications?*
It is important to us if you are taking medications because they will impact on your health and some food ingredients.
- Yes
- No

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Agreement of your Food and Cooking Interests Form*
I agree with my answers in this form.
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Your Food & Cooking Interests Assessment Form