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Food Allergy Form Template

Ensure safety with a comprehensive food allergy form

Collecting crucial food allergy information can be overwhelming, but our Food Allergy Form Template simplifies the process. Designed for schools, camps, and healthcare providers, this template helps you gather essential details to ensure the safety of individuals with allergies. You'll benefit from easy customization to fit your needs, instant online access for quick distribution, and secure data collection that keeps sensitive information safe. Plus, this WCAG-aligned form ensures accessibility for all users. Explore this template now and enhance your allergy management.

Use this Template (FREE) Live Preview
Full name
Email address
Phone number
Who are you completing this form for?
Self
Parent/guardian
Spouse/partner
Relative
Friend
Caregiver
Prefer not to say
Other
Please Specify:
Do you have any food allergies or intolerances?
Yes
No
Which food allergens apply to you? Select all that apply.
Have your food allergies been diagnosed by a healthcare professional?
Yes
No
What reactions have you experienced? Select all that apply.
What is the most severe reaction you have experienced?
Severe (anaphylaxis)
Moderate
Mild
Never had a reaction
Unsure
How sensitive are you to trace amounts and cross-contact?
Cannot tolerate any trace amounts or cross-contact
Can tolerate trace amounts but not as an ingredient
Ingredients only; cross-contact is acceptable
Unsure/Not sure
Do you have a prescribed epinephrine auto-injector (e.g., EpiPen)?
Yes
No
Do you typically carry your epinephrine auto-injector during visits/events?
Yes
No
Additional allergy details or instructions
What accommodations do you need? Select all that apply.
Emergency contact name
Emergency contact phone number
Relationship to you
Parent/guardian
Spouse/partner
Relative
Friend
Caregiver
Other
Please Specify:
I give permission for this information to be shared with relevant staff for safety and accommodation purposes.
Yes
No
Name of person providing consent
Date
I confirm the information provided is accurate to the best of my knowledge.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration depicting a food allergy form template for FormCreatorAI article

When to use this form

Use this form before you serve meals in restaurants, schools, camps, daycare, offices, and events. It gives you clear details on triggers, severity, and emergency steps, so you can prep safe dishes and avoid cross-contact. Add it to online booking or intake flows to capture risk early. Use the Waitlist form to note allergies before seating. The Catering order & contract form keeps guest allergy notes tied to the order. The Food evaluation form helps you learn which dishes work for guests with sensitivities. Managers, chefs, and front-of-house staff all benefit from fewer surprises and fewer incidents.

Must Ask Food Allergy Questions

  1. Which foods or ingredients cause your allergic reactions?

    This tells your kitchen exactly what to avoid and where cross-contact risks hide. Listing ingredients (peanuts, tree nuts, shellfish, sesame, dairy, eggs, soy, wheat, gluten) reduces guesswork and errors.

  2. How severe are your reactions, and what symptoms do you get?

    Severity and symptoms guide prep, service notes, seating, and response time. If reactions include anaphylaxis, staff can flag the ticket and route it to trained team members.

  3. Do you require strict cross-contact controls (separate utensils, fryer, and prep area)?

    This sets clear process changes before the order reaches the line. It also helps you decide whether you can safely serve the guest.

  4. Do you carry epinephrine or other emergency medication, and where will it be?

    Knowing this speeds response in a worst-case event. Ask guests to keep it accessible so staff can retrieve it fast if needed.

  5. Who should we contact in an emergency, and how can we reach them?

    A direct contact gives you backup if the guest needs help. The Restaurant evaluation form helps you confirm the guest felt safe and heard after the visit.

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