The Optimum Health
Clinic Foundation
Registered Charity Number: 1131664
Bickerton House
25-27 Bickerton Road
London
N19 5JT
Email:
fundraising@optimumhealthclinic.com
Recipe Submission Form
This form should be completed by anyone who wants to submit a recipe for The Optimum Health
Clinic Foundation’s Fundraising Recipe Book.
We are happy for you to submit as many recipes for the book as you wish but if you want to submit
more than one recipe, then please fill in a separate form for each recipe.
The purpose of this book....
Many patients who attend the Clinic are encouraged to make changes to their diet in order to
support their recovery. This can often mean changing habits of a lifetime which can understandably
be very difficult. Additionally suffers of M.E/CFS can often find the task of preparing healthy meals
tiring. The purpose of this recipe book is to provide a selection of tasty tried and tested recipes
which meet specific diet requirements and/or are quick and healthy.
You can submit a recipe for any type of dish, however we are ideally after either recipes which can
be classified as ‘free-from’ or are quick to prepare and cook. Either way we need to check a few
things with you before the recipe can be published. We must ensure that we give credit for all the
contributions made to the book and crucially that we do not infringe on copyright restrictions in the
process of publication.
Section 1 – Your details
Name: Click here to enter text.
Address: Click here to enter text.
Telephone Number(s): Click here to enter text.
Email: Click here to enter text.
-1-
Section 2 - Recipe
First of all, we need to know the name of your recipe.
Click here to enter text.
We really want to know why you have chosen to submit this recipe to us. What is it about the recipe
that you like? Is it because it is easy and quick, or avoids a forbidden food. Let us know in the box
below.
Click here to enter text.
Have you cooked this recipe yourself?
Yes
No
To help readers follow your recipe we need as accurate details as possible about both the
ingredients and the cookery method. Recipe examples are available online at
www.freedomfromme.co.uk/foundation/
INGREDIENTS
Below, please provide the ingredients required for the recipe, including the amount of each
ingredient. If possible, please provide the measurements in metric measurements (grams and
litres). We will provide a conversion table in the final product.
Click here to enter text.
METHOD
Please provide the recipe method or instructions. This should include all the steps to making
your recipe, timings and temperature (ideally in degrees Celsius). We will provide a conversion
table in the final product for temperatures.
Click here to enter text.
TIMINGS
Can you give an estimation of how long it will take to prepare and cook your dish.
Preparation time: Click here to enter text.
Cooking time: Click here to enter text.
PORTIONS
Can you estimate how many people your dish should serve.
Click here to enter text.
-2-
Some of these recipes may have certain food groups missing. They may be wheat, gluten or dairy
free. (Please note this is not a requirement for submitting a recipe)
Please indicate if your recipe is any of the following. (Please indicate all that apply. To highlight a box, please
double click on the box and select ‘ checked’)
Vegetarian
Vegan
Wheat free
Gluten free
Diary Free
Sugar Free
Other
Please State: Click here to enter text.
We are also looking to include some quick recipes, these are recipes that take under 30 minutes to
prepare and cook. Do you consider your recipe to be quick? (Please tick as appropriate)
Yes
No
Section 3 - Copyright
It is very important that we make sure that no recipes included in the book infringe on copyright
legislation, whereby the original creator of a piece of work is not given due credit and people copy it
and claim it as their own. These rules are quite straightforward when they are applied to a book or a
piece of music but when it comes to recipes it is a little less clear. After all, recipes are often passed
on from one person to another over generations, with occasional changes along the way. Even world
famous chefs copy other people’s ideas. Even so, it is important we make all attempts possible to
ensure that we do not breach copyright. Therefore we need to ask you a few questions about your
recipe. Please don’t worry about these questions just answer them as best you can and if you do
have a recipe from another author that is absolutely fine, just let us know.
Please indicate as appropriate. (One option only. To highlight a box please double click on a box and select
‘checked’)
1.) The recipe submitted is a direct copy of a recipe I have found. (The ingredients and
method are the same.)
2.) The recipe submitted has the same ingredients as a recipe I have found, but a different
recipe method.
3.) The recipe submitted has been adapted from a recipe I found, and has slightly different
ingredients and a different method.
4.) The recipe submitted on this form is entirely my own work. I came up with the
ingredient list and method myself.
-3-
If you ticked options 1, 2 or 3, please fill in the following section. If you ticked option 4 then please
move to section 4 of this form.
For those who ticked options 1, 2, or 3 can you please give details, where possible, of where you got
the original recipe from.
Author: Click here to enter text.
Title of Book/Website/Magazine: Click here to enter text.
Date of Publication: Click here to enter text.
Page number (if appropriate): Click here to enter text.
URL (if appropriate): Click here to enter text.
I do not know where the recipe originally came from.
(Please tick if appropriate)
Where possible if you have a copy of the original recipe, please submit a copy of it with this
form. It can be scanned and attached to an email to
fundraising@optimumhealthclinicfoundation.com or alternatively posted to The Optimum
Health Clinic Foundation, Bickerton House, 25-27 Bickerton Road, London, N19 5JT. Please
include your name and address with the recipe. Please note that posted copies cannot be
returned.
Section 4 - Recipe check
As I am sure you can appreciate, one of the important steps in developing this recipe book for the
Foundation is to ensure that there are no mistakes in any of the recipes that we publish. For instance
we need to make sure that simple errors are not made for example about how long something
should be in the oven for. To help complete this recipe check we are looking for some volunteers.
For this we would give you a recipe (or two) submitted by other people which you then trial run for
us. A perfect excuse to try some new tasty food!
Would you be willing to trial run other recipes submitted to the book?
Yes
No
If yes, please give details of any recipes/food you would not want to trail run
Click here to enter text.
Section 5: Nutrition Questions
As well as including a selection of exciting tried and tested recipes we also hope to include
nutritional information to help suffers of M.E/C.F.S, amongst others. One idea we have for this
special recipe book is to include a question and answer section, where you have the chance to pose
your nutrition questions to one of the Optimum Health Clinic’s nutritionists. After all the chances are
that if you have a burning question about nutrition, someone else would also like to know the
answer too! With this in mind we would like to give you the opportunity to ask a nutrition focused
-4-
question to a nutritionist. You can write your question in the box below. Please note, that we may
not be able to publish and answer all the questions.
Click here to enter text.
Section 6: Declaration
First of all, thank you for submitting a recipe to The Optimum Health Clinic Foundation’s Recipe
Book. We really do appreciate it. We hope you are as excited as we are about this project. However
it is important that you understand a few things before we proceed with your recipe submission.
As yet, it is difficult to anticipate the number of recipe submissions we will receive. In the event that
we receive a high number of recipes it may not be able to publish all the recipes submitted to us.
Furthermore, if we receive multiple recipes for similar dishes then we may have to decide to only
print one of the recipes in order to prevent duplication. Furthermore a recipe may not be included if
it is felt that the recipe is not appropriate to be published by The Optimum Health Clinic Foundation.
It will remain at the discretion of The Optimum Health Clinic Foundation team which recipes to
include in the recipe book.
Additionally, it may in some cases be necessary to make some small adjustments to recipes before
they are submitted. For example if we feel that the method given by you in the recipe submission is
deemed too similar to the method of the original recipe. We may also make small changes to
submitted recipes where we feel we need to establish further clarity in the method or we need to
create consistency between recipes to be published (e.g the use of metric measurements). In the
unlikely event that we need to make substantial adjustment to the recipe you submitted before
publication we will contact you on the details you provided at the beginning of this submission form.
Even if adjustments are made to the recipe for such reasons, credit for the recipe submission will still
be given to the original contributor.
Lastly, it is important to remind you that if you have any questions regarding the Foundation’s recipe
book project at any stage, then please contact the team by email on
fundraising@optimumhealthfoundation.com or by telephone on 0845 226 1762.
Please tick the statements and sign and date below to confirm that you have read and understood
the statement below.
I understand that submitting this recipe to The Optimum Health Clinic Foundation
does not guarantee that the recipe will be published. The Optimum Health Clinic Foundation
team will make the final decision on what recipes will be included in the published recipe
book.
I understand that if my recipe is to be published adjustments may be made to the
recipe for the reasons outlined above. I will still be given credit for my contribution and will be
informed of the adjustments.
I understand that all proceeds from the sale of the recipe book will go to The
Optimum Health Clinic Foundation to support their ongoing projects.
I have provided accurate information regarding the original source of the recipe.
-5-
I am happy for the recipe submitted on this form to be published in a recipe book for The
Optimum Health Clinic Foundation.
Sign: Click here to enter text.
Print Name: Click here to enter text.
Date: Click here to enter text.
Thank you for completing this form. You can either email the completed form to
fundraising@optimumhealthfoundation.com or post it to The Optimum Health Clinic
Foundation, Bickerton House, 25-27 Bickerton Road, London, N19 5JT.
Forms should be submitted by the 28th February 2013
-6-