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Run: Resident Dining Preference and Food Allergy Profile

Resident Dining Preference and Food Allergy Profile template for capturing meal likes, dislikes, allergies, diet texture needs, and seating preferences in on...

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Resident Identification

Resident Name (required)

Resident ID or Room Number

Use the resident ID or room number if your facility uses one.

Date of Birth

Optional. Only collect if needed to accurately identify the resident.

Primary Contact Name

Consent and Information Use

I consent to this information being shared with relevant dining and care staff for meal planning, allergy safety, and resident support. (required)

Yes No N/A

May the dining team share relevant meal preference and allergy information with nursing or care staff if needed for safety? (required)

Additional instructions for staff

Use this field for any information that helps staff support the resident during meals.

Dining Preferences

Favorite Foods

Foods to Avoid

Meal Temperature Preference

Preferred Snack Times

Allergy and Sensitivity Details

Does the resident have any food allergies or severe sensitivities? (required)

Allergen(s) (required)

Severity (required)

Reaction Description

Describe the typical reaction and any emergency steps staff should know.

Diet, Texture, and Portion Needs

Diet Type

Does the resident need a texture-modified diet? (required)

Portion Size Preference

Meal Assistance Needed

Cultural and Seating Preferences

Cultural or Religious Food Preferences

Seating Preference

Social Dining Preference

Additional Notes

Add any other dining-related information that would help staff support the resident.

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Email (required)

Your name (optional)

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