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Industry-Specific

Dietary Restrictions & Food Allergy Needs Assessment

Captures the dietary restrictions, allergies, and intolerances your customers or diners live with, how strictly they follow them, and where current food options fall short — with an AI follow-up that digs into a real recent incident where those needs weren't met and what would have prevented it.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全13問・約7分
Q01
メッセージ

Thanks for taking a few minutes to share your dietary needs with us! This helps us design safer, more accommodating food options. Your responses are completely confidential and anonymized. Should take about 5 minutes, and there are no wrong answers.

Q02
選択式必須

Which of the following best describes your dietary situation? (Select all that apply)

  • Food allergy (e.g., nuts, shellfish, dairy)
  • Celiac disease or gluten intolerance
  • Lactose intolerance
  • Vegetarian
  • Vegan
  • Religious dietary requirement (e.g., halal, kosher)
  • Medically prescribed diet (e.g., low-sodium, diabetic)
  • Other intolerance or sensitivity
  • No dietary restrictions
Q03
オピニオンスケール必須

How strictly do you need to follow your dietary restriction to avoid negative consequences (illness, discomfort, or personal/religious conflict)?

スケール: 1 – 5
最小:Minor preference, flexible最大:Must avoid completely, no exceptions
Q04
選択式必須

In the last 30 days, how often did you have to skip a meal, dish, or event because there was no safe or suitable option for you?

  • Never
  • Once
  • 2-3 times
  • Weekly or more
Q05
マトリクス必須

When eating somewhere new, how confident are you in the following?

4行 × 5列
  • That menus or labels clearly flag ingredients relevant to you
  • That staff understand cross-contamination risks
  • That you can find at least one safe option
  • That asking about your restriction won't cause delay or friction
列: Not at all confident · Slightly confident · Somewhat confident · Confident · Very confident
Q06
選択式

What do you currently rely on most to check if food is safe for you?

  • Reading ingredient labels myself
  • Asking staff or the kitchen directly
  • Restaurant/brand website or app filters
  • Third-party allergy or diet apps
  • Advice from friends/family who know my restriction
  • I mostly avoid unfamiliar places altogether
Q07
ベスト・ワースト選択（MaxDiff）必須

When choosing where to eat or what to buy, which of these matter most to you versus least?

  • Clear allergen labeling
  • Dedicated allergen-free menu section
  • Staff trained on cross-contamination
  • Ability to customize/substitute ingredients
  • Certified (e.g., gluten-free, kosher, halal) products
  • Fast, friendly response when I ask questions
  • Price of allergen-friendly or specialty items
各セットで最も良いもの・最も悪いものを選択最も良い:Matters most最も悪い:Matters least
Q08
評価スケール必須

Overall, how well do restaurants and food brands you currently use accommodate your dietary needs?

範囲: 1 – 5
最小:Very poorly最大:Very well
Q09
AIインタビュー

Ask the respondent to walk through the most recent specific time their dietary restriction was NOT accommodated well — where it happened, what went wrong (mislabeling, staff not knowing, no options, cross-contamination), and what they did in the moment. Probe whether it was a one-off or a pattern, and what single change would have prevented the problem. If they said they've never had an issue, explore what specifically makes a place feel 'safe' to them so we can identify what to replicate.

Q10
選択式

How likely are you to recommend a restaurant or brand specifically because it handled your dietary needs well?

  • Very unlikely
  • Unlikely
  • Neutral
  • Likely
  • Very likely
Q11
選択式

What is your age range?

  • Under 18
  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65+
  • Prefer not to say
Q12
選択式

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q13
メッセージ

Thank you for sharing this with us! Your answers will directly inform how we label, prepare, and communicate about food so people with dietary needs like yours feel safer and more welcome.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Includes a dedicated AI follow-up interview that asks respondents to walk through a specific recent incident where their dietary needs weren't met and what would have prevented it — turning a checkbox answer into a real story with root-cause detail
  • Combines structured measurement (strictness scale, a matrix on confidence eating somewhere new, a MaxDiff on what matters most when choosing where to eat) with open narrative probing, so you get both quantifiable patterns and qualitative context
  • Captures behavioral frequency (meals/events skipped in the last 30 days) and current coping mechanisms (what people rely on to check food safety) rather than only restriction type
  • Ends with brand-relevant outcome questions (likelihood to recommend based on accommodation, overall rating of current options) so results tie directly to business impact, not just demographics

Jotform

Dietary Restrictions Form Template

A static, fielding-ready form template built on Jotform's drag-and-drop form builder, intended mainly for collecting dietary info (e.g., at events or restaurants) rather than researching underlying needs. It's easy to customize and deploy quickly but is structured as a data-collection form, not a research instrument designed to surface unmet needs or incidents.

優れている点

  • Quick to customize and deploy via a widely used form builder
  • Simple, familiar format for collecting basic dietary/allergy info
  • Likely integrates with Jotform's broader form and workflow ecosystem

物足りない点

  • No adaptive AI follow-up — fixed fields only, no probing into specific incidents
  • No automated per-response quality scoring
  • No voice interview option or transparent prompt methodology

SurveySparrow

Dietary Restrictions Form - Collect Guest Preferences

A conversational-style survey template positioned for hospitality/guest-preference use cases, filed under SurveySparrow's healthcare template category. It benefits from SurveySparrow's chat-like UI for higher completion rates, but it's a fixed-question template rather than one built to dynamically dig into specific past incidents.

優れている点

  • Conversational, guest-friendly survey format
  • Positioned for hospitality-specific guest preference collection
  • Part of a broader template library with reporting dashboards

物足りない点

  • No adaptive AI-driven follow-up questioning based on individual answers
  • No voice AI interview mode
  • No automated quality scoring of open-ended responses

Typeform

Dietary Restrictions Form

A polished, conversational one-question-at-a-time form template using Typeform's standard logic-jump branching. It's well-suited for a clean respondent experience but relies on pre-set logic paths rather than true adaptive AI interviewing that reacts to open-ended answers in real time.

優れている点

  • Clean, high-completion conversational interface
  • Supports basic logic branching between questions
  • Easy to embed and match to brand styling

物足りない点

  • Logic jumps are pre-built branching, not real adaptive AI follow-up on open responses
  • No voice AI interview capability
  • No automated response quality scoring or transparent AI prompt disclosure

よくあるご質問

「Dietary Restrictions & Food Allergy Needs Assessment」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が13問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes to share your dietary needs with us! This helps us design safer, more accommodating food…」・「Which of the following best describes your dietary situation? (Select all that apply)」・「How strictly do you need to follow your dietary restriction to avoid negative consequences (illness, discomfort, or pers…」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、13問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

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