Templates › Forms › SEO page

Run: Resident Dining Preference and Food Allergy Profile

Capture each resident’s dining preferences, food allergies, texture needs, and mealtime support in one clear profile. Use it to help staff serve safer, more ...

Fill this out, get a PDF emailed to you. No account required. Want to run it with your team and track results? Sign up free →

Resident Identification

Resident full name (required)

Resident ID or MRN

Optional if your facility uses a resident identifier. Do not collect if not needed.

Date completed (required)

Completed by

Name and role of the person completing this form, if applicable.

Consent and Information Use

I understand this information will be used by care, nursing, and dietary staff to support meal planning and food safety. (required)

Yes No N/A

Consent to share profile with dietary and kitchen staff (required)

Yes No N/A

Preferred contact method for follow-up questions

Dining Preferences

Favorite foods

Foods to avoid

Meal time preferences

Additional dining notes

Use this field for brief, relevant details only.

Allergy and Sensitivity Details

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

Allergy or sensitivity details

Severity level

Epinephrine or emergency response plan on file

Diet Texture and Nutrition Support

Current diet type

Texture modification

Fluid consistency

Nutrition support notes

Include only information needed for safe meal service and care coordination.

Mealtime Assistance and Cultural Preferences

Does the resident need mealtime assistance? (required)

Assistance details

Cultural or religious food preferences

Special instructions for staff

Use for brief, actionable instructions only.

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Generated with MangoApps Templates — browse 250+ free