What is your diagnosis, and which medicines do you take?
A notice needs the food or ingredient, not a medical history. Diagnoses and medicine lists are sensitive and are not needed to prepare a meal.
RestaurantForms
Allergy and dietary notice form: tell the kitchen, then tell your server
An allergy and dietary notice form gives a guest a written way to name a food allergy or dietary need before a visit, so your team can plan with the kitchen. It is a notice, not a confirmation: allergen handling stays with the restaurant under its own procedures and local food safety rules, and the server still needs to hear the need directly when the guest arrives.
Questions to leave out
What a meal notice should not collect
Please attach your allergy action plan or a letter from your doctor.
The form has no file uploads. A named food or ingredient is what the kitchen acts on, and a medical document does not replace it.
Do you accept responsibility if a dish makes you unwell?
Legal wording about responsibility belongs with your counsel, not on a notice form. Keep this form to the information the kitchen needs.
Can you guarantee that there is no trace of the ingredient?
No kitchen can promise that for every dish. Describe your process in the form's introduction instead, such as the steps staff take for a flagged order.
What is your full home address and date of birth?
Not needed for a meal notice. Collect a name and, if you want a call back, a phone number.
Field blueprint
Nine fields that describe the need for the kitchen
| Field | Type | Required | Why you ask it |
|---|---|---|---|
Guest name | Short text | Required | Lets the host and the server match the notice to the guest and the party. |
Phone numberLeave this blank if you would rather confirm in person. | Phone | Optional | Lets your team call back before the visit if a dish needs to be confirmed. |
Visit date | Date | Required | Tells the team which service the notice applies to. A notice for a much later date should be sent again closer to the visit. |
Number of people with this need | Number | Required | Shows how many plates need a change, so the kitchen can plan the adjusted dishes. |
Type of needFood allergyIntolerance or sensitivityDietary choice (for example vegetarian or vegan)Religious or cultural requirementOther | Single choice | Required | Separates a food allergy, which the kitchen must plan around, from a preference it can accommodate in other ways. |
Food or ingredient to avoidOne food per line. Include oils, sauces or stocks if they matter to you. | Long text | Required | Names exactly what must not be served. The kitchen acts on the food or ingredient, so name it. |
Anything else the kitchen should knowDescribe the need. Do not include diagnoses or medicine details. | Long text | Optional | Captures cross-contact concerns or how the guest wants the dish prepared, such as a separate pan. |
Next stepsI will also tell my server when I arrive.I would like a call before my visit. | Multiple choice | Required | Confirms the guest knows this form is not enough on its own, and records whether they want a call before the visit. |
Email address (optional)Only needed if you want a written reply. | Optional | Gives a written reply route only if your team uses one. |
Words for the respondent
Wording that sets the right expectation
Introduction
Tell us about a food allergy or dietary need before your visit. Our team shares this notice with the kitchen. Please also tell your server when you arrive.
Confirmation
Thank you. We have your notice. This form does not confirm how any dish is prepared. Please tell your server when you arrive, and ask them to check with the kitchen.
Type of need
A food allergy and a preference need different planning. Choose the closest match.
Food or ingredient to avoid
Name the food or ingredient, one per line. Be as specific as you can.
Phone number
Leave this blank if you would rather confirm in person.
Next steps
Tick the first box even if you also want a call.
A filled example
A completed notice for a party of two
Example only, not a real submission
- Guest name
- Morgan Example (fictional)
- Visit date
- Saturday, October 24, 2026
- Number of people with this need
- 2
- Type of need
- Food allergy
- Food or ingredient to avoid
- Peanuts, including peanut oil
- Anything else the kitchen should know
- Please use clean pans and utensils for my plate.
- Next steps
- I will also tell my server when I arrive.
After a response arrives
What staff do with a notice
Do not rely on the grid for a same-day notice
Processing happens in an hourly scheduled job in production, and the creator is notified afterward. For a visit the same day, a manager should tell the kitchen directly and note on the table record that it was done.
Confirm the plan with the kitchen
Check the named food or ingredient against the dishes the party may order, and agree the change in writing on the kitchen ticket. Do this under your own allergen procedure.
Call back when the guest asked for one
If the guest ticked the call box, call before the visit and confirm the plan. If you cannot confirm a dish, say so and suggest one you can confirm.
Keep allergen handling with your own procedure
Allergen handling is the restaurant's responsibility. Follow your written procedure and your local health department's food safety rules, and train staff on both. This form supports that process; it does not replace it.
Frequently asked questions
Does this form prevent allergic reactions?
No. A form cannot prevent an allergic reaction. It gives your team a written notice to plan from, and the kitchen's procedures and the server's direct confirmation still need to happen.
Is there a dietary requirements form template?
Lift this field list into your own document to draft a notice. Keep the food to avoid, the type of need and the next-step choice, and check the wording with your health department or a food safety adviser before you use it.
Should a guest with an allergy use this form instead of telling staff?
Use the form in addition to telling the restaurant directly, not instead of it. A guest should also tell the server when they arrive, because the kitchen needs to hear the need from the person handling the order.
Do I need a medical document from the guest?
Usually not. The kitchen needs the food or ingredient to avoid, not a diagnosis or a medicine list. Ask for a medical document only if your own process requires it, and get counsel's advice on how to handle it.
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