LBC Diet and Allergy Survey LBC Diet and Allergy Survey Name(Required) First Last Email(Required) Do you have any food allergies?(Required) No Yes, diary Yes, nuts Yes, shell fish Yes, gluten Yes, other (please specify) If you have any food allergies other than those listed, please specify them here. Do you have anu dietary restrictions or needs?(Required) No Vegetarian - lacto-ovo Vegetarian - lacto Vegetarian - ovo Vegan Kosher Halal Other (please specify) If you have dietary restrictions or needs other than those listed, please specify them here. Do you have any health concerns we should know about (e.g. heart condition, asthma, addiction, activity restrictions, mobility needs)?(Required) No Yes (please specify) please specify Please list any alerrgies (e.g. insect bites, severe skin allergies, latex) and what you may need if you have an allergic reaction.
