Here is your opportunity to let Melissa Metcalf Le Roy know what you prefer in your customized menu. Please check preferences and add comments.

MEATS:
Beef (steak/roasts/ground round)Pork (chops/roasts/ribs/bacon/ham/ground)Veal (stew/ground/scallops)Lamb (chops/stew/ground/roasts)MeatloafMeat and vegetable/pasta casseroles

POULTRY:
Chicken (breasts/thighs/ground/etc.)Turkey (breasts/smoked/ground/scalloped/etc.)Chicken or turkey meatloafChicken or turkey and vegetable/pasta casserolesDuck (breast/thighs/Confit/Foie Gras)

FISH/SHELLFISH:
Fish (Anchovies, dover sole, halibut, salmon, striped bass, orange roughly, catfish, snapper, trout, swordfish)ShrimpScallopsCrabLobsterClamsMusselsTuna (canned, fresh)

SALADS:
Fresh Green (Iceberg lettuces, Romaine, red leaf, Bibb, mixture, spinach, etc.)FruitPastaSalads as a main dish?

SALAD DRESSINGS:
MayonnaiseRanchVinaigretteFrenchOil/vinegarRed wine/vinegarThousand IslandOther (identify)

SOUPS:
CreamedHotColdChunkyClearWith meat/poultrySoups as a main dish

VEGETABLES:
Green (artichokes, avocado, arugula, bok choy, broccoli, brussel sprouts, capers, peas, green beans, spinach, asparagus, peppers, celery, snow peas, cucumber, eggplant, endive, green onion, cabbage, mustard greens, kale, okra, olives)Orange (Carrots)Yellow (corn, wax beans, peppers)Red (pimento, red cabbage, beets, tomatoes, peppers, sweet potatoes/yams, radicchio, radish, sun-dried tomatoes)White (cauliflower, potatoes, parsnips, bean sprouts, mushrooms, leeks, hearts of palm, jicama, water chestnuts)Beans (black, ranch-style, pinto, kidney, lima, white, pink, Edamame (soy), fava, garbanzo (chickpeas), lentils, navy, cannellini)Onions (cooked, raw, shallots)Squash (baby squash, summer, yellow, zucchini, acorn, spaghetti, butternut)

GRAINS:
Bran (wheat/oat)Bulgur wheatGranolaMilletOatmealOrzoPastaPita (whole wheat)PotatoesRice (Brown, white)CouscousQuinoaWheat (tortilla, flour)Corn (tortilla, kernel, meal)Other (identify)

FRUITS/BERRIES:
Red ( Apple (juice, fresh), Cherries, Cranberries, Grapes, strawberries, watermelon)Orange (Apricot, Cantaloupe, Grapefruit, mango, nectarine, orange, papaya, peach)Yellow (Banana, lemon, pear, pineapple)Purple/Blue ( Blueberries, Fig, plum, raspberries, black berries)Coconut (flakes, Milk)Dried Fruit (Dates, Fig, plum, raisins, currants)Green (Grapes, Honeydew, Kiwi, lime)

BREADS:
WheatWhiteRolls (white or wheat, sour dough, etc.)BiscuitsCornbreadMuffinsPancakesWafflesTortillas

SEASONINGS/FLAVORS:
Basil, bay leaves, cayenne pepper, Oregano, sage, rosemary, tarragon, fennel, cumin, cilantro, paprika, parsley, celery, chili powder, chili pepper, Cinnamon, cocoa powder, crushed red pepper, curry, dill, parsley, mint, saffron, thymeFresh garlic, garlic-trace, ginger, Horseradish, WasabiSugar (Brown, White)Pepper—white, black or redSalt—regular or Kosher, Sea SaltBarbeque sauce, Marinara SauceSweet SaucesChocolate, Vanilla, Graham CrackerCoffee, Alcohol/LiquorsHoney, Maple Syrup, Molasses, Agave NectarMayonnaise, Mustard, KetchupPickles, Pickled VegetablesMirin, Miso, Soy sauce, Teriyaki Sauce, Sweet & Sour SauceSalsa- Fruit, TomatoSmokedVinegar, Worcestershire

FATS/OILS:
ButterMargarineOil (Canola, Corn, Olive, Vegetable, Flaxseed, Sunflower, Peanut)LardShortening

MILK AND MILK PRODUCTS:
Cheeses (parmesan, cheddar, Swiss, muenster, feta, mozzarella, goat, fontina, soy, etc.)Milk (skim, 1%, 2%, whole)ButtermilkCottage cheese/Ricotta cheeseCream CheeseYogurtSour creamHalf and half/Heavy Cream

EGGS:
WholeYolks onlyWhites onlyEggbeaters substitute

OTHER:
Tofu (Block, mashed)TempehSoy-based meatless productsNuts (pecans, peanuts, peanut butter, pine nuts, walnuts, almonds, macadamia, cashews, Brazil, soy nuts)Seeds (poppy, sesame, pumpkin, sunflower)

List any vegetables or fruits you don’t ever want to see:

List any other food dislikes:

List any known food allergies VERY IMPORATANT!

Are you currently on a restricted diet? If yes, describe:

What diet programs, plans, or products have you tired in the past?

Do you have any history of the following: heart disease or stroke, diabetes, high blood pressure, high cholesterol, digestive disorder, depression, sleep disorder, cancer, other describe:

Have you had surgery within the last year? If yes, what type?

Are you pregnant?

Do you exercise? Please describe the types, frequency, and duration:

What do you eat on a typically Day?

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