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Dietary information form template

Tell a kitchen exactly what someone can and can’t eat.

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How to make a dietary information form

  1. 1

    Check the questions: rename, add or delete any field, or change how it’s answered.

  2. 2

    Add your organisation’s name, a contact line and your logo if you like.

  3. 3

    Choose fillable PDF, printable PDF, Word or HTML, and the paper size.

  4. 4

    Download the dietary information form and share it, print it or add it to your website.

About this dietary information form

Schools, camps, hostels, hospitals, care homes and office canteens serve people with many diets: vegetarian, vegan, Jain, halal, kosher, gluten-free, diabetic or soft-textured, plus allergies and intolerances. A dietary information form records them clearly so kitchens can plan menus and avoid mistakes.

For one-off events, the meal preference form is shorter. For severe allergies, add an allergy action plan.

What’s on the dietary information form

The template has 5 sections and 12 questions. Every one can be renamed, moved or deleted.

  • Person: Name; Group, class or room; Date
  • Diet: Diet (tick all that apply: Vegetarian, Eggetarian, Non-vegetarian, Vegan, Jain, Halal, Kosher, Gluten-free, Diabetic, Low salt); Religious or cultural needs
  • Allergies and intolerances: Food allergies (dangerous); Intolerances (e.g. lactose); Allergy action plan attached (yes or no)
  • Eating: Texture (choose one: Normal, Soft, Minced, Puréed); Needs help with eating (yes or no); Strong dislikes
  • Signature: Signature with date

Tips

  • Separate allergies (dangerous) from preferences (dislikes).
  • Share the form with the kitchen and serving staff, not just the office.
  • Review it each term or season.

Four ways to save it

A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.

Frequently asked questions

What texture options mean?

Some people need soft, minced or puréed food because of chewing or swallowing difficulties. Care homes and hospitals often use standard texture levels.

Can I record religious fasting?

Yes. Use the religious or cultural needs field, for example fasting days or no beef or pork.

Can I change the questions on the dietary information form?

Yes. Rename any question, change its answer type (short answer, tick boxes, rating, table and more), move it, or delete it. You can also add whole new sections.

Can I put the dietary information form on my website?

Yes. Choose “HTML” to copy ready-made form code with labels and a simple style. Set the form’s action to the address that should receive submissions, such as your own form handler.

Can I get the dietary information form as a Word document?

Yes. Choose “Word” under “Save as” to download a .docx file you can keep editing in Microsoft Word, Google Docs or LibreOffice.

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