Elderly Food Preference Questionnaire
Please help us understand your food preferences and mealtime needs to ensure a comfortable dining experience.
Full Name
*
First Name
Last Name
Do you have any dietary restrictions?
Vegetarian
Vegan
Gluten-Free
Lactose-Free
Low-Sodium
Other
Do you have any food allergies?
Peanuts
Tree Nuts
Dairy
Eggs
Seafood
Wheat
Soy
Other
Which cuisines do you enjoy?
American
Italian
Asian
Mexican
Mediterranean
Other
Are there any foods you dislike or avoid?
Preferred meal times
Breakfast (7-9 AM)
Lunch (11 AM-1 PM)
Dinner (5-7 PM)
Snacks
Do you have any texture preferences?
Soft foods
Pureed foods
Crunchy foods
No preference
Preferred portion size
Small
Medium
Large
Do you require assistance during meals?
No assistance needed
Occasional assistance
Regular assistance
Additional comments or special preferences
Submit
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