prepared meals.jpg — New Client Intake Form

for Natasha Wellness Meal Delivery

Hello! Thank you for taking the time to fill out my intake form. This form gathers delivery instructions as well as your dietary needs and preferences.

Name

First Name

Last Name

Email Address

Birth date

YYYY

Cell phone number

We will text you once your meals have been delivered.

(###)

###

####

How did you hear about us?

Who can we thank for your business?

Desired Delivery Date

Options are Monday's or Wednesday's

YYYY

How many meals would you like delivered?

Here, meals are defined as a lunch/dinner that feeds one person. There is also the option to add on breakfast, dessert and snacks. If you're interested in add-ons please mention that in your comments below.

Please explain what you're interested in if you selected "Other" above / What add-ons you would like.

Where would you like your meals dropped off?

Typical delivery fee within the Greater Boston Area is $30 unless otherwise stated. Pickup in Winthrop is free.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If you are not home during the delivery window (typically 12pm-5pm) will you be able to leave out a cooler with ice packs out for me to store your food in?

Yes

No (Please make sure the meals can be picked up soon after delivery or taken in by concierge or someone else. We are not responsible for meals that are left out for long as temperature changes can vary.)

If I am delivering your meals, please give me detailed instructions on how I can get the meals to you including parking, door code, where to leave the meals if it's raining/snowing, etc.

Frequency of delivery

How often would you like to receive your meals?

What are your ultimate health goals?

Which foods do you NOT eat?

Food Allergies

Please list any food allergies or intolerances you may have. This is a great place to mention if cross-contamination is an issue.

Favorite Foods

Restaurants, cuisines, ingredients, flavors

Have you used a meal delivery service before? If so, which one and why did you stop using them?

Is there anything else you'd like me to know?

Is there anything else that I should know before I begin?

Cancellation Policy: Cancellations made less than 7 days before client’s scheduled delivery date will be subject to a $50 fee.