Q01
Message
All templates
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.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
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
Opinion ScaleRequired
How strictly do you need to follow your dietary restriction to avoid negative consequences (illness, discomfort, or personal/religious conflict)?
Scale: 1 – 5
Min:Minor preference, flexibleMax:Must avoid completely, no exceptions
Q04
Multiple ChoiceRequired
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
MatrixRequired
When eating somewhere new, how confident are you in the following?
4 rows × 5 columns
- 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
Columns: Not at all confident · Slightly confident · Somewhat confident · Confident · Very confident
Q06
Multiple Choice
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
Best–Worst Trade-off (MaxDiff)Required
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
Pick best & worst per setBest:Matters mostWorst:Matters least
Q08
Rating ScaleRequired
Overall, how well do restaurants and food brands you currently use accommodate your dietary needs?
Range: 1 – 5
Min:Very poorlyMax:Very well
Q09
AI Interview
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
Multiple Choice
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
Multiple Choice
What is your age range?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q12
Multiple Choice
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q13
Message
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.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- 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 TemplateA 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.
What it does well
- 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
Where it falls short
- 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 PreferencesA 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.
What it does well
- Conversational, guest-friendly survey format
- Positioned for hospitality-specific guest preference collection
- Part of a broader template library with reporting dashboards
Where it falls short
- 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 FormA 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.
What it does well
- Clean, high-completion conversational interface
- Supports basic logic branching between questions
- Easy to embed and match to brand styling
Where it falls short
- 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
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.