Food Allergy Form
Learn about Food Allergy Forms and use our template for your practice if you don’t have your own yet!
Fact Checked by Ericka Pingol.
What are allergies?
Allergies are what happens when a person becomes exposed to an allergen. Allergens are what trigger reactions from a person’s immune system. These triggers vary from person to person. Some people have allergic reactions when exposed to animal fur. Some have allergic reactions to pollen, mold, dust, taking specific medications, and getting bit or stung by an insect. In the case of this guide, we’ll be focusing on allergic reactions caused by food.
When people are exposed to allergens, their immune system will begin to create Immunoglobulin E, an antibody that triggers the body to release allergen-fighting chemicals like histamine. It’s when these chemicals are produced that people start experiencing allergy symptoms.
For mild cases, people will likely start sneezing and have stuffy or runny noses. Their eyes might become teary and itchy. Speaking of itchy, their skin might develop eczema or hives, and they will often start scratching affected areas. Their throats might also become itchy.
For severe cases, people will not only have symptoms from mild cases, but they might also feel nauseated, start vomiting, have diarrhea, start wheezing and coughing, and have shortness of breath. The worst that can happen is anaphylaxis, a life-threatening state characterized by blood pressure dropping to abnormally low levels, difficulty breathing, and loss of consciousness.
Printable Food Allergy Form
Download this Food Allergy Form to keep track of patient’s allergies.
How do Food Allergy Forms work?
Food Allergy Forms are essential clinical tools that help healthcare professionals collect information about a patient’s allergies. These are not limited to healthcare professionals, though. Schools, restaurants, daycares, and workplaces sometimes have these forms ready to gather information about students, customers, and workers.
These forms ask users to specify the food that triggers their allergies, symptoms, and severe allergic reactions.
Our template asks users to detail the following information:
- Their personal information (specifically their full name, age, contact information, etc.)
- Their medical history (this should be related to their allergies)
- Specific food allergens (this is a checklist, but there’s an Others section for specific allergens not on the list)
- Allergic reaction severity rating (mild, moderate, or anaphylaxis)
- Emergency contacts and action plan (so people know what to do to manage the allergic reactions and know who to turn to if such an event occurs)
This is an essential document for people with allergies at all times. In case allergic reactions occur somewhere that isn’t their home, let’s say an office or school, people there can look at the Food Allergy Form and determine what they can do for the person who had an allergic reaction.
It’s also a precaution for places that offer food, like office and school cafeterias. Staff can avoid serving food that may trigger a person’s allergies.
Food Allergy Form example (sample)
Now that you know the gist of allergies and have been acquainted with what to expect from our Food Allergy Form template, it’s time to see what our template looks like.
All a person needs to do is fill the empty fields with all the necessary information about their allergy and then tick the appropriate checkboxes for some sections. It would be best to be as detailed as possible when writing information in the Emergency Plan box, so people have steps to follow immediately in case of allergic reactions.
You can print this (recommended so that there’s a physical copy that people can refer to) and fill it out with a pen, or go paperless and fill out the PDF file. The template has interactive portions.
If you like what you see and believe this will be an excellent way to record your or your patient’s allergies, please download our free Food Allergy Form PDF template!
Download this Food Allergy Form example:
When is it best to use this Food Allergy Form?
During hospital or clinic visits
Suppose a person is in the hospital because of a food allergy. In that case, healthcare professionals can issue a Food Allergy Form to the person or their companion to indicate information about the patient’s allergies. This will be used for documentation and added to a patient’s medical history. It can also help healthcare professionals determine what particular treatment they should provide based on the severity of the allergic reaction and what caused it.
During a dining experience
This will likely be the most appropriate time to use a Food Allergy Form. If the restaurant, cruise, or whatever organizer is keen on accommodating people with specific allergies and particular dietary preferences, the staff can use this form to gather information from customers, or the customers can bring a copy of a filled-out form themselves. This form should provide the necessary information to the staff to prepare for the dining experience and prevent allergic reactions.
In school or work settings
Schools and offices should have Food Allergy Forms so that staff are aware of any allergies their students or employees may have. This is so they can make the necessary preparations to ensure that the school or office environment is safe for students or employees with allergies. They can make adjustments like ensuring particular desks or office rooms are squeaky clean for those allergic to dust or by ensuring alternative food options in the cafeteria.
What are the benefits of using a Food Allergy Form?
Specific people will become aware of a person’s allergies
Besides documenting that a person has allergies, Food Allergy Forms are made to disseminate information about people with allergies among relevant parties. Relevant parties include school staff, office staff, restaurant staff, family members, friends, and healthcare professionals. By becoming aware of people’s allergies through these forms, these parties can take precautionary measures and develop protocols to reduce or eliminate the risk of allergic reactions.
People become prepared for emergencies
Speaking of taking precautionary measures, one of the defining features of Food Allergy Forms, or at least our template, is the emergency plan section. Suppose a person has an allergic reaction despite them and other people taking the necessary precautions. In that case, the information in the emergency plan section should help people manage allergic reactions.
Reduced risk of having allergic reactions
While it’s not a one-hundred percent guarantee that risks for allergic reactions will ultimately be eliminated (accidents can happen after all, sometimes through negligence), Food Allergy Forms have the power to help people ensure that there are little to no chances of allergic reactions from happening.
Commonly asked questions
Usually, the person with the allergy fills it out. If the person with the allergy is a child or is physically incapable of filling it out, their parents, siblings, loved ones, friends, caregivers, guardians, or a nurse can fill it out on their behalf.
If the form is handed to a healthcare professional, they will keep a copy for documentation.
For some institutions like schools and childcare facilities. In this context, these forms help ensure that these institutions' staff comply with mandates concerning the safety of people with allergies.
No. They aren’t legally required to issue Food Allergy Forms. Each restaurant has a set menu and may or may not accommodate those with food allergies or special dietary requirements. They’re not obligated to adjust to people with such allergies/requirements.
