Nutrition Services | Registered Dietitian Consulting Group
FOOD PREFERENCESDIETSUPPLEMENTS/SNACKSFOOD ALLERGY & INTOLERANCE(S)MAJOR FOOD GROUP PREFERENCE Vegetarian No Meat Dislikes Fish Dislikes Milk Religious/Cultural Diet Restrictions: Adaptive Equipment Needed:Chewing/Swallowing Difficulties:BEVERAGE PREFERENCEBreakfast Juice: _______________ WaterMilk: Yes No Coffee Cream Sugar Decaf Coffee Cream SugarLunch WaterMilk: Yes No Other: _______________ Coffee Cream Sugar Decaf Coffee Cream SugarDinner WaterMilk: Yes No Other: _______________ Coffee Cream Sugar Decaf Coffee Cream SugarOTHER DIET PREFERENCESNAME: PHYS:RM:MR#: ................
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