JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Allergy and Dietary Restrictions
If you would like to share with us your information, we can better serve you on campus, and reach out with information on your dietary preferences.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your first and last name?
*
Your answer
Best email address to contact you?
*
Your answer
Best contact phone number?
Your answer
What is your Loyola ID number?
*
Your answer
What year are you?
Freshman
Sophomore
Junior
Senior
Other:
Clear selection
Do you have a
*
Food Allergy
Food Intolerance
Special Perscribed Diet
Lifestyle choice
Have you registered with Disability Support Services (if an allergen, disability, or medically prescribed diet that requires accommodations)?
*
Yes
No
What is your allergen/food restriction/diet?
*
Your answer
If consumed what is your reaction (if applicable)?
Your answer
Would you like to set up a meeting with a chef or a manager on campus to discuss your dietary options on campus?
Yes
No
Clear selection
Any additional information you want to share, or any suggestions?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
