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Food Intolerance & Allergy Questionnaire Form

Food Intolerance & Allergy Questionnaire Form

Document a client’s reactions, triggers, and severity safely, capturing allergies, intolerances, and management in one form.

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Description

The Food Intolerance and Allergy Questionnaire Form gives practitioners a careful way to document a client’s reactions before advising on their diet. It captures any known allergies, how the client reacts and how severe it is, and whether they carry an adrenaline auto-injector, so safety comes first.

Fields for suspected intolerances, which foods cause discomfort, how they manage reactions, and whether they have had formal testing complete the picture. An emergency contact and an acknowledgment ensure the most serious cases are flagged and handled with appropriate care.

Knowing the risks keeps advice safe. Sign up for a free Fun Forms account to customize the fields and embed this questionnaire on your website.

Form fields

Everything the Food Intolerance & Allergy Questionnaire Form above collects — 11 fields, so you can see exactly what it captures before you make it your own.

Allergies & Intolerances

Do you have any known allergies?
Multi-Select
Describe your reaction and how severe it is
Long Answer
Do you carry an adrenaline auto-injector (EpiPen)?
Yes/No
Any suspected intolerances (not diagnosed)?
Multi-Select
Which foods cause discomfort, and what happens?
Long Answer
How do you usually manage reactions?
Dropdown
Have you had formal allergy testing?
Yes/No
Your name
Name
Email address
Email
Emergency contact number
Telephone
Acknowledgment
Consent

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Template FAQs

Common questions about the Food Intolerance & Allergy Questionnaire Form — what it captures, when to use it, and how to make it your own.

What is a food intolerance and allergy questionnaire form?

A food intolerance and allergy questionnaire form is an online form that documents a client’s reactions to foods. It captures allergies, intolerances, severity, and management, so a practitioner can advise on their diet safely and avoid recommending anything that could cause harm.

Why ask whether a client carries an auto-injector?

Whether a client carries an adrenaline auto-injector indicates the severity of their allergy, potentially anaphylactic. Knowing this flags the most serious cases, so you take extra care, avoid trigger foods entirely, and ensure the client’s safety is the first priority in any advice.

Why distinguish allergies from intolerances?

Allergies and intolerances differ greatly in mechanism and risk, from life-threatening reactions to digestive discomfort. Capturing them separately, and whether any have been formally tested, helps you understand the real level of risk and give safe, appropriate guidance rather than treating them the same.

Why record how a client manages reactions?

Knowing how a client usually manages reactions gives useful context about their experience and the severity involved. It helps you understand what already works for them and ensures your advice fits alongside how they cope, keeping them safe and comfortable with their diet.

Why include an emergency contact?

For clients with serious allergies, an emergency contact is a sensible safeguard should a reaction occur. Capturing it, alongside an acknowledgment, reflects the care that food allergy work demands and ensures someone can be reached quickly if the situation ever calls for it.

Is the food intolerance and allergy questionnaire form free?

Yes, this food intolerance and allergy questionnaire form is completely free, and you can customize the fields to fit your practice, embed it on your website, and go live with no coding required. Just create a free Fun Forms account to start documenting reactions online.

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