Please fill in this questionnaire as thoroughly as possible.
Once you submit your answers you will receive details on how
to make payment. Payment must be received within 24 hours of
questionnaire submission. If confirmation of payment is not
received before then, your questionnaire will be discarded.
Name
E-Mail
Phone
Mobile
Postal Address
Who referred you to Recipes by Request?
Are these recipes for ?
Baby
Age
Toddler
Age
Child
Age
Teen
Age
Adult
Age
What are your available methods for cooking
Wok
Oven
StoveTop
Microwave
BBQ
Breadmaker
SlowCooker
Steamer
Do you own, or are you willing to purchase:
Food Processor
Blender
Freezer
Ice Cream Maker
What are your cooking skills?
Beginner
Intermediate
Advanced
How much time do you have to cook?
Not Much
Average
Heaps of time
Which of these do you prefer
Fresh Herbs
Dry Bottled Herbs
Crunchy Food
Soft Food
Spicy Hot Food
Spicy Mild Food
When unrestricted with food choices, what do you enjoy? (ie. What will you miss most on your restricted diet?):
Japanese
Pizza
Indian
Fish & Chips
Chinese/Asian
Anything Fried
Italian
Burgers & Chips
Vegetarian
Vegan
Can you have:
Canned products
Frozen products
Do you prefer
Light Breakfast
Heavy Breakfast
Light Lunch
Heavy Lunch
Light Dinner
Heavy Dinner
Do you have
Unlimited access to health food shops & supplies?
Limited access to health food shops & supplies?
No access at all (only mail order).
Following you will find a lists of foods. Tick off as appropriate.
Please do not cross out items you have not tried yet. Simply ticke them off as NOT TRIED.
Since you are on a restricted diet, now is the time to be open to new flavours and tastes to give you a
larger variety to choose from (even if you are one of those fussy teenagers!). By marking NT beside the items
you have not tried I will then keep recipes with these ingredients to a minimum just so you can try them.
I have also left plenty of space for you to add any foods I may have left out that you eat often.
If there is anything else you wish to add which I have not covered, or special requests for certain recipes
please do so here. If I have any queries when compiling your recipes then I will contact you. Otherwise please
allow up to 4 weeks to receive your recipe book.
VEGETABLES
FRUIT
NOT ALLOWED
DO NOT LIKE
NOT TRIED
NOT ALLOWED
DO NOT LIKE
NOT TRIED
Alfalfa sprouts
Apple
Asparagus
Apricot
Beans
Avocado
Beetroot
Banana
Bean Sprouts
Blueberries
Bok Choy
Cherries
Broccoli
Coconut
Broccolini
Kiwifruit, Gold
Brussel Sprouts
Kiwifruit, green
Cabbage
Grapes, Red
Carrot
Grapes, Green
Cauliflower
Melon, Rock
Celery
Melon, Water
Chokoes
Melon, Honeydew
Artichokes
Limes
Choy Sum
Lemons
Corn
Lychees
Cucumber
Mandarin
Eggplant
Mango
Fennel
Mulberries
Capsicum, Green
Nectarine
Capsicum,Red
Olives
Capsicum, Yellow
Orange
Capsicum, Orange
Passionfruit
Peas, Green
Paw Paw
Peas, Snow
Peaches
Peas, Sugar Snap
Pear
Leeks
Pineapple
Lettuce
Plums
Mushrooms
Raspberries
Onion
Grapefruit, white
Parsnip
Grapefruit, Ruby
Squash
Cranberries
Swede
Figs
Pumpkin
Starfruit
Radishes
Strawberries
Spring Onions
Tangelos
Silverbeet
Tangerines
Spinach
Tomato
Potato, sweet
Potato, White
Rocket
Turnip
Watercress
Zucchini
DAIRY
MEAT
NOT ALLOWED
DO NOT LIKE
NOT TRIED
NOT ALLOWED
DO NOT LIKE
NOT TRIED
Butter
Bacon
Cheese, cheddar
Prosciutto
Cheese, cottage
Anchovy
Cheese, cream
Turkey
Cheese, feta
Tofu
Cheese, goats
Beef
Cheese, mozzarella
Bugs
Cheese, parmesan
Chicken
Cheese, ricotta
Clams
Cream, Coconut
Crab
Cream, Sour
Ham
Cream, thickened
Lamb
Eggs, white
Lobster
Eggs, yolk
Mackerel
Ghee
Mussels
Margarine
Oysters
Milk Coconut
Perch
Milk, almond
Pork
Milk, cows
Prawns
Milk, goats
Quail
Milk, oat
Red Emperor
Milk, rice
Salami
Milk, soy
Salmon
Nuttlex
Sausages
Yoghurt, cows
Scallops
Yoghurt, goats
Shark, Flake
Yoghurt, sheep
Snapper
Squid
Swordfish
Trout
Tuna
Veal
Other Foods you enjoy:
Other relevant comments:
How would you like to receive your personalised cook book? (Book cost $100)