Allergies and Food Restrictions Survey

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

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Bloss Up Food Survey
1

Do you have any food allergies?

Please select all that apply.
2

Rate your level of concern regarding food restrictions.

1 being not concerned at all and 10 being very concerned.
3

Please specify any dietary restrictions or preferences

Please provide details about your dietary requirements.
4

Are you following a specific diet?

Please choose if you are following any specific diet.
5

Have you had any allergic reactions in the past?

Please select all that apply.
6

Rate the importance of accommodating dietary restrictions.

1 being not important at all and 10 being extremely important.
7

Please specify any specific food allergies.

Write down any specific food items you are allergic to.
8

Are you lactose intolerant?

Please select if you are lactose intolerant.
9

How often do you encounter food restrictions in your daily life?

Choose the frequency of encountering food restrictions.
10

Additional comments or notes regarding your dietary needs.

Feel free to add any extra information about your dietary needs.
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