Allergy Form

Please enter your data

Your name:
Cultural diets
Dietary information:
I am a vegetarian/vegan I am a diabetic I keep kosher I am Muslim I do not drink alcohol
Food incompatibility
Intolerances:
Lactose Gluten Fructose
Allergies
Fish/ Meat
Egg
Grains:
Wheat Soy Rye Spelt
other grains:
Vegetables:
Celery Bell pepper Cabbage Legumes
other vegetables
Nuts:
Hazelnuts Walnuts Peanuts
other nuts
Spices/additives:
Soduim glutamate Paprika Garlic Curry Cinnamon
other spices
Fruits:
Kiwi Apples/pears Grapes Citrus fruits Cherries Pineapple Peaches Plums
other fruits
other food allegies:
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