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RETREAT
CLIENT FORMS

Please submit this survey and we will do our best to accommodate everyone as a group and provide delicious and healthy meals to help reset your body as well as your mind.

Client Food Survey

First name*

Last name

Email*

Phone

Do you have any food allergies

Yes

No

If so, to what food or foods?

In the case of accidental exposure what type of treatment will you require? Do you use an epipen?

Are you on a vegan diet?*

Yes

No

Are you on a vegetarian diet?*

Yes

No

Do you have an dietary restrictions?

Yes

No

If so please describe in detail so that we may offer a substitute if possible.

Do you have to exclude any of the following from your diet.

Red Meat

Pork

Poultry

Dairy

Grains

Fruit

Certain Vegetables

Sodium

Sugar

What is your favorite food that you eat consistently? For us to get an idea of flavor preferences.*

Besides foods listed above, what is your least favorite food?*

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CONTACT US

Name

Email

Phone Number

Thanks for submitting!

ADDRESS

160 S Center St. Cumberland Maryland 21502

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RETREAT CLIENT FORMS

Client Food Survey

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RETREAT
CLIENT FORMS