Food Preferences Step 1 of 8 12% Name* First Last Phone*Email* Enter Email Confirm Email Below are a list of foods for each food category. Please indicate whether you love, like/ willing to eat, or dislike each food item. If there are any items that you would like to see on your diet plans that you do not see on this list, please list on the last page of this food preferences form. Also, if you have a favorite or least favorite kind of one of these foods, PLEASE WRITE IT TO THE SIDE OF THE ITEM.Breads, Cereals, and GrainsWhole grain breads (whole wheat, rye, Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). White Bagels Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Whole Grain Bagels Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). English Muffin Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Toast Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Whole Grain Crackers (Wheat thins, Triscuits, etc.) Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Tortillas Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Regular muffins Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Whole grain or Bran muffins Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Oatmeal, Regular Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Instant Oatmeal Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Brown Rice Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). White Rice Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). White Pasta Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Whole Wheat Pasta Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Cold cereals Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Fruits/Fruit JuicesApples Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Raspberries Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Blackberries Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Mango Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Kiwi Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Bananas Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Strawberries Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Blueberries Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Grapes Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Cantaloupe Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Grapefruit Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Oranges Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Peaches Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Pears Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Pineapple Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Dried fruits (Raisins, Banana chips, Craisins, apricots, pineapple, etc.) Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Lemons Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Apple sauces Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Orange Juice Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Grapefruit Juice Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Apple Juice Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Watermelon Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Fats and OilsOlive oil Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Butter Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Mayonnaise Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Miracle Whip Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Creamy Salad Dressing Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Low fat Salad Dressing Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Vinaigrette Salad Dressing Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Dairy2% milk Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). 1% milk Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Skim milk Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Low Fat Chocolate Milk Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Almond Milk Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Soy Milk Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Greek Yogurt Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Fruit Yogurt Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Plain Yogurt Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Hard Cheese: Cheddar, Colby, Monetary Jack, Swiss, etc. Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Soft cheese: Goat, Fetta, Ricotta, etc. Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). American Cheese Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Cream Cheese Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Cottage Cheese Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). VegetablesLettuce (Romaine or mixed greens) Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Spinach Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Kale Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Carrots (raw or cooked) Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Tomatoes Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Corn Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Peas Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Green beans Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Beets Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Zucchini Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Yellow Squash Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Cauliflower Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Broccoli Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Brussels sprouts Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Cabbage Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Asparagus Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Acorn Squash Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Butternut Squash Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). White potato Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Red/new potatoes Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Mashed Potatoes Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Sweet Potatoes Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Avocado Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Olives Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Onions Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). ProteinAlmonds Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Sunflower seeds Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Walnuts Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Peanut butter Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Steak Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Pot Roast Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Hamburger meat Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Pork Chops Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Ham Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Bacon Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Sausage Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Chicken Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Turkey Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Tuna Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Shrimp Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Salmon Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). COD Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Tilapia Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Lunch meat Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Eggs Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Hot dogs/Brawts Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Hummus Dip Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Pistachios Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Cashews Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Desserts/SweetsJell-O Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Ice Cream Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Cool Whip Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Pudding Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Fruit and Granola parfait Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Granola Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Granola Bars Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Breakfast bars Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Frozen Yogurt Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Sherbet Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Honey Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Jelly/Jams Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Please List your 3 favorite sweet treats: MiscellaneousTacos Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Fajitas Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Guacamole Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Chips and Salsa Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Spaghetti Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Lasagna Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Stir fry Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Soups Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Popcorn Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Pizza Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Stuffed peppers, tomatoes, or mushrooms Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Casseroles Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). BBQ sauce Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Steak sauce Love Like/willing to eat Dislike if you have a favorite or least favorite kind, (PLEASE WRITE IT HERE). Please add any foods that you either would like to see on your diet plan or would NOT like to see on your diet plan that are NOT included in this list:Would like to see on my diet plan:Would NOT like to see on my diet plan:Please mark the answer that best describes you for the following questions.How many days a week do you eat breakfast? None 1-2 Days 3-5 Days 6-7 Days Which best describes your evening meal? Largest meal Medium sized meal Light meal Rarely eat dinner Are you a vegetarian? Yes No Are you a vegan? Yes No Do you have any religious or other food restrictions? Yes No Please specify: What type ethnicity do you eat most like (ex: American, Indian, Hispanic, etc.) How many cups of water do you typically drink each day? 0-1 1-2 3-5 6-8 >6 Do you usually use non-fat or reduced fat products? Yes No Which would mostly describe your work or daily activities? Sitting Standing Walking Heavy Labor How many days per week do you exercise for 20 or more minutes? Thank you!NameThis field is for validation purposes and should be left unchanged.
