Nutrition and Diet Services Nutrition Services for Companies and Consumers

Diet or Menu Analysis Order Form

Please complete the nds Service Selection and Client Information form and this order form then print and FAX both completed forms to Nutrition & Diet Services (503) 654-3669

Name: Date:
Company Name if Applicable:

What to send:

For Menu's: Check those items desired. Send your menu clearly identifying (underline) each item to be included in the analysis.

Number of Meals and Snacks per Day (select one):
3 meals - 2 snacks 2 meals - 2 snacks 1 meal

Cycle: Number of weeks Number of days/week

Diet Variations:

Regular	Low Sodium	Diabetic	Low Cholesterol /Low Fat
Renal	Other

Describe Food Type and Give Your Standard Portion Size:

Milk	whole	2%	1%	skim
Juices	unsweetened		sweetened
Fruits	fresh	frozen	canned	packed style
Entree	breakfast	lunch	dinner portion size
Vegetables	fresh	frozen	canned	salted	unsalted
Dressings	regular	reduced fat	nonfat	other
Fats	butter	stick_margarine	soft_margarine	oil type
Breads	white	wheat	roll in ounces	other
Beverage/Condiments served each meal:

Describe any other information we need to know about your menu.

For Menus AND Diets:

Dietary Standard to apply:

RDA Standard: Age Range Male Female
DRI Standard

Nutrients to include in Analysis:

Return:

Two weeks from the date we receive the final piece of requested information.

Print completed form and Client Information form and
FAX to nds at (503) 654-3669
For assistance with this form , please phone us at (50 654-3583 8AM-5PM PST

For information regarding prices and ordering see our price list and other nds services.
If you are not completely satisfied with our service, return your analysis within 30 days for a full refund.
Nutrition and Diet Services (NDS) P.O. Box 67070, Portland Oregon 97268
Voice: (503) 654-3583 Fax: (503) 654-3669 email:Nutrition and Diet Services