Food Allergy & Dietary Restriction
Survey
Name
First Name
Last Name
What dates will you be attending trial?
Week 1 only
Week 2 only
Both Weeks
Specific date(s) (please list dates below)
Please list the specific date(s) you will attend trial:
Do you have any food allergies?
Yes (please list below)
No
Please list your food allergies below:
Do you have any dietary restrictions? (ie. vegetarian, vegan, gluten free)
Yes (please list below)
No
Please list your dietary restrictions below:
Submit
Should be Empty: