Food Allergy Meal Plan Modification Request

Example (ABC123)
Are you registered with the Disability Resource Center?
Do you have a medical diagnosis associated with your food allergy?
Impact of Dietary Restriction
Mouth - Itching, tingling, or swelling of lips, tongue, mouth
Skin - Hives, itchy rash, swelling of face or extremities
Gut - Nausea, abdominal cramps, vomiting, diarrhea
Throat - Tightening of the throat, hoarseness, hacking cough
Lung - Shortness of breath, repetitive coughing, wheezing
Heart - Thready pulse, low blood pressure, fainting, pale, bluish skin tone
Asthmatic - Could have a higher risk of severe reaction
Other - Please explain below