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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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샘플 질문

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질문 13개 · 약 7분
Q01
메시지

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
객관식필수

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
의견 척도필수

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

척도: 1 – 5
최소:Minor preference, flexible최대:Must avoid completely, no exceptions
Q04
객관식필수

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
매트릭스필수

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

4개 행 × 5개 열
  • 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
열: Not at all confident · Slightly confident · Somewhat confident · Confident · Very confident
Q06
객관식

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
최선·최악 선택형(MaxDiff)필수

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
세트별 최선·최악 선택최선:Matters most최악:Matters least
Q08
평점 척도필수

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

범위: 1 – 5
최소:Very poorly최대:Very well
Q09
AI 인터뷰

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
객관식

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
객관식

What is your age range?

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

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q13
메시지

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.

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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.

잘하는 점

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

아쉬운 점

  • 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.

잘하는 점

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

아쉬운 점

  • 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

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