Chef Heidi Parks: New Client Form

Full Name

Address

City

State

Postal code

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Email Address *

Phone *

Meat/Poultry

Beef [roasts, steaks, stews, ground]

Lamb [chops, leg, ground]

Poultry [chicken, turkey, ground]

Pork [chops, ham, sausage, bacon, tenderloins, roasts]

Vegetarian [tofu, tempeh, lentils, saitan]

Fish/Shellfish

White Fish [cod, flounder, tilapia, seabags, bronzino, etc.]

Fish Steaks [swordfish, monkfish, ahi tuna]

Salmon [grilled, roasted, broiled, smoked]

Shellfish [shrimp, scallops, lobster, crab, etc.]

Mollusks [oysters, mussels, clams]

Sushi - Raw

Sushi - Cooked Only

Salad

Green Salads [greek, caesar, house, etc.]

Fruit salad [strawberries, mango, apple, blueberries, etc.]

Chopped salads [mainly vegetable salads that have been chopped down]

Vegetable noodle salads

Grain salads

Salads as main course

Soups/Stews

pureed [cauliflower soup, asparagus soup, carrot ginger, etc]

brothy [chicken soup, miso soup, vegetable soup]

stew

soup as main course

Grains

brown rice

white rice

farro

quinoa

millet

amaranth

buckwheat

corn

Eggs

frittatas

quiche

whole egg

egg white only

hard boiled

soft boiled

poached

scrambled

quiche

Herbs/Seasonings

fresh herbs [parsley, tarragon, chives, oregano, basil, sage, rosemary, chervil, thyme]

spices [cumin, coriander, cardamom, chili powder, cinnamon, turmeric, ginger]

seasonings [sea salt, black pepper]

other [chili powder, paprika, red pepper flakes, white pepper]

Oils/Vinegars

olive oil

grapeseed oil

avocado oil

coconut oil

sesame oil

balsamic vinegar

white wine vinegar

red wine vinegar

apple cider vinegar

rice vinegar

Veggies

Green [broccoli, asparagus, zucchini, peas, green beans, brussels sprouts, celery, broccolini, snap peas]

yellow [wax beans, summer squash, spaghetti squash, delicata squash, golden beets]

red [cabbage, beets, tomato, sundried tomato, red bell pepper, sweet potato, carrot, butternut squash, pumpkin]

white [cauliflower, parsnip, bean sprouts, mushroom, leek, onion, garlic]

leafy greens [kale, spinach, collards, arugula, watercress, chard, bok choy]

beans [black beans, white beans, red beans, cranberry beans, chickpeas, soybeans]

dark [eggplant, capers, olives]

Cuisine preference

Mexican [tacos, fajitas, burritos, salsa, guacamole]

thai [flavor profile: ginger, garlic, shallot, fish sauce, coconut milk, chili, lime]

japanese [soy sauce, sesame oil, garlic, lime, scallion]

chinese [soy sauce, chili, garlic, ginger, honey, cashew]

korean [soy, sesame, chili, sweet]

italian [garlic, onion, olive oil, basil, oregano]

mediterranean [olive oil, oregano, lemon juice]

southern [comfort foods, casseroles, chicken pot pie]

french [garlic, onion, chervil, chives, tarragon, sauces]

indian [coriander, cumin, garlic, ginger, cardamom]

other [please list below any favorite cuisines not listed here]

Spice Level

How spicy do you like your food?

none
mild
medium
hot
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If you selected other, please explain

Favorite Foods & Desserts

Favorite Restaurants

Food Quality - I like to purchase the same kind of foods you normally buy for your family. Please check any items that apply:

Organic proteins

Organic produce

Organic products [rice, quinoa, oils, etc]

Grass fed meats

Free range poultry

Wild, sustainable fish/shellfish

Conventionally grown fruits/vegetables

Conventionally raised proteins/poultry/fish

Other

Dietary Preferences

Gluten free

Dairy Free

Grain Free

low carbohydrate

low sugar

low sodium

kosher

egg free

nut free

other

If you selected other, please explain

Food Allergies

How often would you like service?

multiple times per week
weekly
bi-weekly
bi-monthly
monthly
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