FOOD & ACTIVITY PREFERENCES

Name

First Name

Last Name

Foods You Enjoy Eating!

Please make a list of foods you like

Foods You Do Not Like!

Please make a list of any foods you dislike

Food Allergies

Please list any food allergies you have

Activities you enjoy!

Please make a list of any activities you enjoy and/or can perform easily

Activities you do not enjoy!

Please make a list of any activities you either dislike and/or can not perform currently