Elder Homes Group | C O N S T A N T L Y C A R I N G

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Head Office
Thorpe House
Harwich Rd · Little Clacton · Essex
CO16 9NJ
01255 860737

food questionnaire

Homes Name :

Email Address :

Service Users Name:

Completed by:

Relationship:

Staff Position:

Dear Service User,

We at Elder Homes, place a high importance on providing fresh, healthy and appetising food for our service users. The emphasis is on quality, freshly prepared food, with all meals being well balanced and highly nutritional. We change our menus throughout the seasons using local suppliers of dairy and organic produce where possible, 90% of the food is freshly prepared at our homes.

Our menus are designed around our service user's choices. Through our questionnaires and from your feedback, we are able to incorporate our customer's food preferences therefore allowing each menu to be tailored to our customers needs.

We also provide a personal one to one service with our chef should our daily menu's not meet your needs.This service can be arranged through your home manager.

We constantly care about our food and offering choices to our customers. We would like to thank you for taking the time to complete this questionnaire.

Special Diets

		Yes/No
1.	Gulten Free
2.	Dairy Free
3.	Vegan
4.	Diabetic
5.	Kosher
6.	Halal
7.	Other (Please Enter Below)

8.	Do You Have Food Allergies (If yes, please list below what types of food you have an allergy to)

9.	Do you require blended food (If yes, please list any special requirements below)

Food / Drinks

Please Cohoose your favourite drinks
1.	Hot Drinks
2.	Cold Drinks
Your Breakfeast
1.	Cereal(s)
2.	Eggs how do you like them?
3.	Bread - Brown or White
Meats
1.	Please list your favourite meat
Fish
1.	Please list your favourite fish
Seafood
1.	Please list your favourite seafood
Vegetables
1.	Please list your favourite vegetable
Potatoes
1.	Please list your favourite potatoe (e.g boiled, mashed, roast, jacket, chips)
Fruit
1.	Please list your favorite fruit
Your Desserts
1.	Please list your favorite desserts
Your favourite sandwich
1.	Brown / White
2.	Please list your favorite sandwich filling
Biscuits
1.	Please list your favorite Biscuits (e.g. Chocolate or plain)
Cake
1.	Please list your favorite cake

Lunch / Light Meal

All of our lunches are served with a choice of potatoes, vegetable and salad.

Desserts

What would you like to see on our menu if we do not already have it?

Should you wish to bring something into the home for your loved one to enjoy please let us know

If there is anything we can do to improve our service please contact our customer services manager

Brian Dragoonis
Email: bad@elderhomes.co.uk

We care about

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