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Food Allergy Customer Trust & Safety Survey

Captures how confidently people managing food allergies navigate menus, ingredient labels, and staff interactions at restaurants and food brands — and where that trust breaks down. An AI follow-up interview reconstructs their most recent close call or unclear-labeling experience in detail. Built for restaurants, food manufacturers, and allergy-focused brands.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

13 questions · ~7 min
Q01
Message

Thanks for taking a few minutes to share your experience managing food allergies when eating out or shopping for food. Your answers help brands make allergy safety less stressful. About 5 minutes.

Q02
Multiple ChoiceRequired

Which of the following food allergies or intolerances do you personally manage?

  • Peanut
  • Tree nuts
  • Milk/dairy
  • Egg
  • Wheat/gluten
  • Soy
  • Fish
  • Shellfish
  • Sesame
Q03
Opinion ScaleRequired

How confident are you that restaurants and food brands can safely accommodate your allergy today?

Scale: 1 – 10
Min:Not at all confidentMax:Extremely confident
Q04
MatrixRequired

How trustworthy do you find each of these sources of allergen information?

4 rows × 5 columns
  • Printed menu allergen labels
  • Verbal confirmation from waitstaff
  • Packaged food ingredient labels
  • Third-party allergy certifications or apps
Columns: Not at all trustworthy · Slightly trustworthy · Moderately trustworthy · Very trustworthy · Completely trustworthy
Q05
Multiple ChoiceRequired

In the last 3 months, how often have you avoided a restaurant or food product because the allergen information wasn't clear enough?

  • Never
  • Once
  • A few times
  • Almost every time I eat out
  • I no longer eat out because of this
Q06
Rating ScaleRequired

Thinking about the most recent menu or food label you checked for allergens, how would you rate its clarity?

Range: 1 – 5
Min:Very unclearMax:Very clear
Q07
Best–Worst Trade-off (MaxDiff)Required

Which of these changes would most increase your trust in a restaurant or food brand's allergy safety?

  • Clear on-menu allergen icons
  • Dedicated allergen-free prep area
  • Staff trained in allergen handling
  • Real-time ingredient lookup tool online
  • Third-party allergy safety certification
  • Direct hotline to ask about ingredients
  • Separate allergy-friendly menu
  • Guaranteed allergen-free packaging seal
Pick best & worst per setBest:Most increases trustWorst:Least increases trust
Q08
AI Interview

Reconstruct the respondent's most recent close call, reaction, or moment of unclear allergen information at a restaurant or with a packaged product: what happened, how staff or the brand responded, and exactly what information was missing or wrong. Anchor on their earlier answers about avoidance and label clarity, and if they say they've never had an issue, probe what specifically makes them feel safe versus wary in the moment of ordering.

Q09
Multiple Choice

If you've experienced an allergic reaction to food, what was the most severe reaction you've had?

  • I have not had a reaction
  • Mild (itching, rash)
  • Moderate (swelling, digestive upset)
  • Severe (difficulty breathing, anaphylaxis)
  • Prefer not to say
Q10
Short Text

What's one thing a restaurant or food brand could do that would make you feel safest ordering from them?

Q11
Multiple Choice

Which age range do you fall into?

  • Under 18
  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65 or older
  • Prefer not to say
Q12
Multiple Choice

How was your food allergy diagnosed?

  • Diagnosed by a doctor or allergist
  • Self-diagnosed based on symptoms
  • Diagnosed as a child by a parent or caregiver
  • Not formally diagnosed
  • Prefer not to say
Q13
Message

That's everything — thank you for sharing your experience. Your responses will be combined with others to help food brands and restaurants improve allergen labeling and staff training.

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

  • Goes beyond listing allergies by measuring confidence, trust breakdown points, and avoidance behavior across restaurants and food brands
  • Includes an AI follow-up interview that reconstructs the respondent's most recent close call or unclear-labeling experience in their own words, not just multiple-choice data
  • Combines a matrix question on trust in different allergen-information sources with a max-diff exercise to rank which changes would most rebuild trust
  • Captures diagnosis method, reaction severity, and open-ended suggestions alongside quantitative confidence and behavior data, giving restaurants and brands both the 'what' and the 'why'

Jotform

Food Allergy Questionnaire Form Template

A static form template for collecting an individual's food allergy details, likely intended for schools, camps, or events rather than measuring trust or brand experience. It's a fielding-ready intake form, not a research instrument designed to explore confidence or breakdowns in trust.

What it does well

  • Simple, ready-to-use intake form for capturing allergy information
  • Drag-and-drop customization typical of Jotform's builder
  • Free to use for basic form collection

Where it falls short

  • No adaptive follow-up questioning to probe into specific incidents or close calls
  • Designed for data intake, not for measuring trust, confidence, or behavioral avoidance patterns
  • No automated scoring or reporting on response quality or sentiment

SurveySparrow

Free Food Allergy Form - Collect Dietary Information

A healthcare-category form focused on collecting dietary and allergy information, likely for clinics, caterers, or care settings rather than restaurant/brand trust research. It's a static data-collection form, not built to explore lived experiences or trust erosion.

What it does well

  • Positioned within a healthcare template category, suggesting compliance-minded design
  • Free tier availability for basic dietary data collection
  • Conversational form format typical of SurveySparrow's UI

Where it falls short

  • No mechanism to reconstruct or probe a specific recent incident like a mislabeling or close call
  • Lacks trust-scale or max-diff style comparative measurement of brand/restaurant practices
  • No transparent AI prompt methodology or automated per-response quality scoring

Typeform

Food Allergy Form Template

A conversational-style static form for capturing food allergy details, well-suited to friendly UX but not designed to measure customer trust or safety perceptions across restaurants and brands. It's a fielding-ready form, not a trust/behavior research survey.

What it does well

  • Polished, conversational one-question-at-a-time UI
  • Easy embedding for restaurants or brands to collect basic allergy data
  • Mobile-friendly design typical of Typeform templates

Where it falls short

  • No adaptive AI interview to dig into a respondent's most recent unclear-labeling or close-call experience
  • No structured trust matrix or max-diff prioritization of trust-building changes
  • No published methodology for how questions or follow-ups are generated, since none are AI-driven

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