Free Food Allergy Disclosure Form Template

📝 FILL IN YOUR DETAILS

Customer Details

Customer Name

Date

Table / Order Number

Phone (emergency)

Allergy Information

Known Food Allergies

Food Intolerances

Carries EpiPen / Medication?

Allergy Severity

Acknowledgement

Customer Acknowledgement

Customer Signature

Date

Staff Member Notified

Time Noted

Download & Print

💡 Fill in fields → Print / Save PDF → Sign → Keep copy

⚠️ General guidance only. Consult a professional for your specific situation.