Dietary Restrictions Survey

Helps event organizers gather attendees' food preferences, allergies, and needs in a single form.

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Name

Nombre

Apellido

Phone Number

Date of Birth

Do you follow a specific diet?

Yes No

Any special nutritional requirements? (e.g., high protein, low sodium)

Which foods do you avoid?

Dairy Gluten Nuts Shellfish Pork Red meat

Do you have any food allergies?

Yes No

Select food(s) you're allergic to

Peanuts Tree nuts Shellfish Dairy Eggs Soy

Select any symptoms that present with your food allergies

Hives Swelling Difficulty breathing Nausea Anaphylaxis

How severe are your dietary restrictions?

Mild Moderate Severe Life-threatening

Do you require strict cross-contamination prevention?

Yes No

Do you carry emergency medication (e.g., EpiPen)?

Should staff be aware of any emergency procedures?

Emergency Contact Name

Nombre

Apellido

Emergency Contact Phone Number

Any religious or cultural dietary rules?

Are there specific preparation requirements? (e.g., halal-certified, kosher kitchen)

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