Name

First Name

Last Name

Do you have any dietary restrictions/allergies?

Yes

No

Do you enjoy cooking?

Yes

No

Sometimes

Are you interested in plant-based cooking, or do you prefer recipes that include animal products like lean meats or fish?

Prefer plant-based

Enjoy lean meats

Enjoy fish

How would best describe yourself in the kitchen:

Adventurous

Intimidated

Bored

Resentful

Are there any specific health goals you'd like to achieve through your cooking, such as:

Weight management

Increased energy

Improved digestion

How comfortable are you with meal planning and preparation?

Very

Need suggestions at times

Need lots of help

Would guidance around organizing your cooking schedule for the week be helpful for you?

Yes

No

Phone

(###)

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