Food Service Survey - City of Port Coquitlam

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Food Service Survey

Food Service Survey

Name:

My food INTOLERANCES (foods that cause discomfort) are:

My food ALLERGIES (foods that cause an immediate or severe reaction) are:

Are there any ENTREES that you will not eat?

Are there any SOUPS you will not eat?

Are there any VEGETABLES or SALADS you will not eat?

Are there any POTATOES, RICE or PASTA your will not eat?

Are there any FRUIT or DESSERTS that you will not eat?

Do you have any concerns about food service delivery?

Any other comments?