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    Food Preferences Checklist

    Uploaded by

    FhcRojo
    This document is a food preferences checklist that allows a client to indicate which foods they are willing to eat or avoid. It includes sections for breads/grains, fruits, vegetables, animal proteins, plant proteins, dairy, and other foods/styles. The client circles foods they like and crosses out foods they dislike or avoid. Space is also provided to write in specific varieties or types within each food category.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Food Preferences Checklist

    Uploaded by

    FhcRojo
    1K views4 pages
    This document is a food preferences checklist that allows a client to indicate which foods they are willing to eat or avoid. It includes sections for breads/grains, fruits, vegetables, animal proteins, plant proteins, dairy, and other foods/styles. The client circles foods they like and crosses out foods they dislike or avoid. Space is also provided to write in specific varieties or types within each food category.

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    Food Preference Checklist

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    This document is a food preferences checklist that allows a client to indicate which foods they are willing to eat or avoid. It includes sections for breads/grains, fruits, vegetables, animal proteins, plant proteins, dairy, and other foods/styles. The client circles foods they like and crosses out foods they dislike or avoid. Space is also provided to write in specific varieties or types within each food category.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views4 pages

    Food Preferences Checklist

    Uploaded by

    FhcRojo
    This document is a food preferences checklist that allows a client to indicate which foods they are willing to eat or avoid. It includes sections for breads/grains, fruits, vegetables, animal proteins, plant proteins, dairy, and other foods/styles. The client circles foods they like and crosses out foods they dislike or avoid. Space is also provided to write in specific varieties or types within each food category.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4
    At a glance
    Powered by AI
    The document is a food preferences checklist that asks a client to indicate which foods they like or dislike across various categories such as grains, fruits, vegetables, proteins and dairy.

    The checklist covers a wide variety of foods across categories like grains, fruits, vegetables, proteins, dairy and other foods/styles.

    In addition to indicating food preferences, the checklist asks the client to provide their name, date of birth, and to specify any allergies or intolerances.

    Food​ ​Preferences​ ​Checklist

    Client Name: ______________________________ Date of birth: _______________


    Directions:​ ​Circle all foods you are willing or like to eat. Cross out foods you do not like or
    avoid.

    Breads/Grains
    ● Wheat/Multigrain Bread OR specific kind ______________________
    ● White or Brown Rice OR specific kind ________________
    ● Tortillas (Specify corn/flour) _______________
    ● Muffins
    ● Pasta (Specify white/wheat) ______________________________________
    ● Quinoa
    ● Couscous
    ● English muffins
    ● Buns (Hot Dog or Hamburger)
    ● Pretzels
    ● Other(s) __________________________________________________

    Fruit
    ● Apples (Specify types) ______________________________________
    ● Apricots
    ● Avocado
    ● Bananas
    ● Blackberries
    ● Blueberries
    ● Cantaloupe
    ● Cherries
    ● Cranberries
    ● Dried fruit (specify) _________________________________________
    ● Grapefruit
    ● Grapes (red or green)
    ● Honeydew Melon
    ● Kiwi
    ● Lemon
    ● Lime
    ● Mango
    ● Oranges (Specify types) ___________________
    ● Papaya
    ● Peaches
    ● Pears
    ● Pineapple

    Created by Colorado Nutrition Counseling, LLC


    ● Plums
    ● Pomegranate
    ● Raspberries
    ● Rhubarb
    ● Starfruit
    ● Strawberries
    ● Watermelon
    ● Other(s) _______________________________________________

    Vegetables (Specify raw or cooked as needed)


    ● Artichoke
    ● Asparagus
    ● Bean Sprouts
    ● Beets
    ● Bell peppers
    ● Broccoli
    ● Brussel Sprouts
    ● Butternut Squash
    ● Cabbage
    ● Carrots
    ● Cauliflower
    ● Celery
    ● Corn
    ● Cucumber
    ● Edamame
    ● Eggplant
    ● Garlic
    ● Green Beans
    ● Kale
    ● Mushrooms
    ● Onion
    ● Peas (Snap or Green)
    ● Potatoes (specify) ____________________________
    ● Radishes
    ● Seaweed
    ● Spring Mix Salad
    ● Spaghetti Squash
    ● Spinach
    ● Swiss chard
    ● Tomato
    ● Yellow Squash
    ● Zucchini
    ● Other(s) _________________________________________________
    Created by Colorado Nutrition Counseling, LLC
    Animal Proteins
    ● Lean Beef
    ● Chicken
    ● Turkey
    ● Ham
    ● Bacon (specify meat) ____________________
    ● Sausage (specify meat) _____________________
    ● Pork
    ● Shellfish (specify kind) _________________________
    ● Salmon
    ● Other Fish (specify kind) _____________________________
    ● Game (specify kind) _______________________________
    ● Deli meats (specify kind) ______________________________
    ● Eggs
    ● Other(s) ________________________________________

    Plant Proteins
    ● Soup Beans (Specify kind) ______________________________________
    ● Nuts (specify kind) ____________________________________________
    ● Nut Butters (specify kind) ________________________________________
    ● Soy
    ● Tofu
    ● Seeds (specify kind) ____________________________________________

    Dairy
    ● Yogurt (Greek or Regular)
    ● Milk (specify fat content) __________
    ● Non-dairy Milk (specify kinds) ________________________________
    ● Cheese (specify kinds) ________________________________________
    ● String Cheese
    ● Cottage Cheese
    ● Kefir
    ● Other(s) ________________________________

    Other Foods/Styles
    ● Oils (specify) _______________________________
    ● Condiments (Specify) _________________________________________
    ● Dressings (Specify) __________________________________________
    ● Ground Flaxseed
    ● Dark chocolate
    ● Soups/Stews
    ● Wraps
    Created by Colorado Nutrition Counseling, LLC
    ● Sugar-free
    ● Gluten-free
    ● Vegan
    ● Vegetarian
    ● Allergies: _______________________________
    ● Intolerances: ____________________________________
    ● _______________________________
    ● ________________________________
    ● ________________________________
    ● ________________________________

    Created by Colorado Nutrition Counseling, LLC

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