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5 Spice Chef

About
Services
Testimonials
Getting Started
Contact Us

Cook Day Client Assessment

Help Me Curate Amazing Dishes For You and Your Family By Completing This Form

Cook Day Client Assessment

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Progress – Step 1 of 7

Name *

First

Last

Email *

example@example.com

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Method of Communication *

Birthdate *

Entrees and Sides

Please mark ALL that apply.

Do you consider yourself an adventurous diner? *

Yes
No

What level of spiciness do you enjoy in cuisine? *

None
Mild
Medium
Hot
Fiery

Which types of global cuisine do you enjoy? *

Asian
French
Italian
Mexican
Thai
Mediterranean
Other

Do you enjoy vegan options? *

Yes
No

Do you enjoy vegetarian options? *

Yes
No

How many times a month do you enjoy the following?

Beef *

Never
1-2 times
3-4 times
5+ times

Pork *

Never
1-2 times
3-4 times
5+ times

Turkey *

Never
1-2 times
3-4 times
5+ times

Fish *

Never
1-2 times
3-4 times
5+ times

Shellfish *

Never
1-2 times
3-4 times
5+ times

Chicken *

Never
1-2 times
3-4 times
5+ times

Game *

Never
1-2 times
3-4 times
5+ times

How do you prefer your meat, on the bone or off?

Beef *

On
Off
Both

Pork *

On
Off
Both

Chicken *

On
Off
Both

Do you prefer a specific cut of meat?

How do you like your meats prepared? (Where applicable) *

Blue
Rare
Medium Rare
Medium
Medium Well
Well

What flavor levels do you prefer when enjoying seafood? *

Mild
Medium
Strong

Do you like the skin on your meat? *

Yes
No

Do you typically eat bread or rolls with your meals? *

Yes
No

Do you like nuts in main dishes, sides or salads? *

Yes
No

How do you prefer your vegetables? *

Raw
Crisp/Tender
Tender
Soft

Soups

Do you enjoy soup as a main dish? *

Yes
No

Which types of soup do you enjoy? *

Hearty
Broth Based
Creamy
Light
Chunky
Hot
Cold

Do you prefer bread or crackers with your soup? *

Bread
Crackers
No, thanks

Salads

Do you enjoy salad as a main dish? *

Yes
No

Do you prefer a variety of greens? *

Iceberg
Baby Spinach
Spring Mix
Other

What type of homemade dressings do you like? *

Classics
Vinaigrettes
Fruity
Creamy

What is your favorite type of dressing? *

Specifics

What meals would you like included in the plan? Think about family favorites. *

Would you eat the same meal as leftovers? *

Yes
No

Is there a specific grocery retailer you prefer?

For Meat: do you prefer conventional or do you prefer organic meats/wild caught fish?

For Veggies and Fruit: do you prefer conventional or do you prefer organic?

Are there any cuisines, spices, or seasonings you do not care for? For instance, do you like raw red onions? *

Do you enjoy entrees cooked with wine or liquor? *

Yes
No

have crackers enjoy?

Dietary Needs

Do you or anyone in your family have any medical conditions/situations that you would like to manage with diet? *

Yes
No

If you selected yes above, please select all that apply. *

Diabetes
High Cholesterol
Low Fat
Cardiac Conditions
No Fat
High Blood Pressure
Light Salt
No Salt
Digestive Disorder
Other

If you selected 'Other' above, please explain.

Do you or anyone in your family have a gluten allergy? *

Yes
No

Are you or anyone in your family lactose intolerant? *

Yes
No

Does anyone in your household have any other allergies or sensitivities? If so, please list here

Would you like portion control? *

Yes
No

Are you or anyone in your family trying to lose weight? *

Yes
No

Food Dislikes

Please indicate food preferences by checking **DISLIKES**.

Vegetables

Beans

Black Beans
Butterbeans
Cannelini (White Kidney)
Garbanzo (Chickpeas)
Great Northern
Lentil
Navy
Pinto
Red
Refried

Grains

Barley
Couscous
Grits/Polenta
Hominy
Quinoa
Rice, Arborio
Rice, Brown
Rice, Jasmine
Rice, White
Rice, Wild
Wheat

Herbs and Spices

Allspice
Anise
Basil
Caraway
Chervil
Cilantro
Cinnamon
Cloves
Coriander
Cumin
Curry
Fennel
Five Spice
Ginger
Marjoram
Mint
Mustard
Oregano
Paprika
Parsley
Pepper, Black
Pepper, White
Rosemary
Sage
Savory
Sesame
Tarragon
Thyme
Vanilla

Pasta

Angel Hair
Egg Noodles
Fettuccini
Linguine
Orzo
Penne
Shells
Spaghetti
Thin Spaghetti
Whole Wheat
Ravioli
Tortellini
Wheels
Ziti

Cheeses

American
Blue
Brie
Cheddar
Cheddar, Sharp
Colby
Cottage Cheese
Cream Cheese
Feta
Fontina
Goat
Gorgonzola
Gruyere
Jalapeno
Monerey Jack
Mozzarella
Parmesan
Ricotta
Swiss

Seeds and Nuts

Almonds
Cashew
Coconut
Hummus
Macadamia
Pecan
Peanuts
Pesto
Pistachios
Sesame
Sunflower
Tahini
Walnut

Fruits

Apple
Apricot
Banana
Blackberry
Blueberry
Cherry
Fig
Grapes
Melon
Nectarine
Gooseberry
Kiwi
Peach
Pear
Pineapple
Plum
Raspberry
Strawberry
Watermelon

Condiments

Ketchup
Mayo
Mustard, Dijon
Mustard, Ground
Mustard, Yellow
Tartar
Vinegar, Apple Cider
Vinegar, Red Wine
Vinegar, Balsamic

Proteins

Beef
Chicken
Eggs
Ham
Fish, Cod
Fish, Mahi Mahi
Fish, Salmon
Fish, Trout
Fish, Tuna
Game
Lamb
Lobster
Meat Substitutes
Pork
Shellfish (Mussels, Scallops)
Shrimp
Tofu
Turkey

Others

Breads
Sour Cream
Yogurt
Milk
Cream
Chocolate

Kitchen Equipment

Please let me know what equipment you have so I can plan accordingly. Select Yes or No.

Crockpot

Yes
No

Instant Pot

Yes
No

Blender (Vitamix or similar)

Yes
No

Blender (Low Power Model)

Yes
No

Food Processor

Yes
No

Spiralizer

Yes
No

Grill

Yes
No

Rice Cooker

Yes
No

Air Fryer

Yes
No

Meal Plan Client Agreement

(In-Home Meal Prep Clients- Please Skip This Section)

We (5 Spice Chef LLC and Client) have completed a Client Assessment to determine what and how you would like to eat, whether or not there are dietary needs (ie. Allergies, sensitivities or medical concerns). I will use this information to design a custom meal plan for you and/or your family.

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Date

All fees are payable on cook date via Venmo or Paypal. Groceries must be reimbursed as well (if applicable.) Single Session Options: Classic Culinary Session — $350 Includes 3 entrées and 3 sides, serving up to 4 guests. Expanded Culinary Session — $450 Includes 4 entrées and 4 sides, serving up to 4 guests. Additional Guest Service — $400 Customized for 5 guests, includes 3 entrées and 3 sides. Breakfast Enhancement — Add $100 Extend your experience with a curated breakfast selection. Ongoing Culinary Partnerships: Weekly Service — $350 per week Biweekly Service — $800 per month (2 sessions)Monthly Service — $375 per month (1 session)Investment & Payment:All fees are due on the date of service. We accept Venmo and PayPal for your convenience.

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What meals would you like planned?

I strive to make cuisine within your specific dietary preferences, however please as always, seek the advice of a doctor prior to making any significant lifestyle changes.

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The information provided in this plan is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. None of my services shall be used to diagnose or treat any health problem or disease. I cannot and do not provide medical advice. You should seek prompt medical care for any specific health issues and consult your physician before altering your diet. The information and recipes provided in this plan should not be used in place of a consultation with your physician or other health care provider. I do not recommend the self-management of health problems. Should you have any healthcare-related questions, please consult your physician or other health care provider promptly. You should never disregard medical advice or delay in seeking it because of the information provided in this plan.

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I will send a menu a week in advance for you to review. You can and should provide feedback/make changes and requests as necessary. The week’s meals are discussed in accordance with dietary needs and personal tastes. Please respond as soon as you can so I can plan accordingly.

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Cancellation Policy: It is necessary that cancellation requests be submitted at least one week prior to your cook day. Because cook dates for regular clients are scheduled weeks in advance, I cannot guarantee a rescheduled day before your next scheduled cook day. If cancellation occurs within 48 hours of the scheduled session, a $150 cancellation fee applies; cancellation within 24 hours of a scheduled session will result in a $300 cancellation fee (or full session price whichever is greater). Thank you understanding and respect for my time and schedule!

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CONTACT US

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Email: chefmaya@5picechef.com

Call: 904-580-7035

AREAS WE SERVE

Florida, Jacksonville, Jacksonville Beaches, Atlantic Beach, Neptune Beach, Mandarin, Nocatee, and Ponte Vedra Beach.

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