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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Nutrition,Related

Eating Disorder Personal Food Preference Worksheet

Eating Disorder Personal Food Preference Worksheet - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Nutrition, Related


Last revised/reviewed: 11/2015
Contact Clinical Nutrition for questions.
Personal Food Preferences Worksheet
Top 3 Foods: Favorites
List three favorite foods and we will do our best to include them as often as possible into
your meal plan. Please remember we do not honor vegan diets and we do not serve
diet foods, or caffeinated or diet beverages.
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
Top 3 Foods: To Avoid
List three foods that you do not care to eat. We will do our best to limit these foods in
your meal plan, although there may need to be exceptions. Please know that we cannot
exclude an entire food group such as dairy or carbohydrates.
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
*Please note that this food preference sheet will be used for your whole admission. It
cannot be updated or changed while you are here.
Patient Name:
Date:
Copyright © 2015 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM @uwhealth.org Last Revised: 11/2015CCKM@uwhealth.org