Personalized Food Allergy Profile Form

In order to have more accurate results, please only mark foods you know you react or have test results that prove an allergy. Selecting foods which you've been told to avoid but haven't tried or do not have a tested reaction may provide false results. If you have foods that you're not sure about, please use the space at the end of the form to post that information. Also, the more details you can provide the more accurate this will be. Thank you.


Nuts: (please only select the nuts for which you've reacted or tested positive for an allergy.)

Almond
Brazil nut
Butternut
Cashew
Filbert
Hazelnut
Macadamia
Peanut
Pecan
Pine Nuts
Pinion Nut
Pistachio
Walnut

Meats/Proteins:

Fish (fresh water)
Seafood (salt water)
Shellfish
Seaweed (Kelp, Nori, Spirulina)
Sea Salt
Chicken
Egg (chicken)
Egg (duck)
Duck
Goose
Pheasant
Beef/Cow
Bison/Buffalo
Deer
Pork/Pig

Vegetables/Plants:

Grains/Flour:

Amaranth
Arrowroot
Barley
Buckwheat
Corn/Maize
Millet
Oats
Quinoa
Rice
Rye
Sorghum
Spelt
Tapioca
Teff
Wheat

Veggies:

Alfalfa
Anaheim Pepper
Artichoke
Arugula
Asparagus
Avocado
Bamboo
Banana Pepper
Adzuki Bean
Fava Bean
Green Bean
Lima Bean
Navy Bean
Pinto Bean
White Bean
Beets (beet sugar)
Bell Pepper
Bok Choy
Broccoli
Brussel Sprouts
Cabbage
Canola
Carrot
Cassava
Cauliflower
Cayenne
Celery/Celeriac
Chamomile
Chard (Swiss, Red, Green)
Cherry Pepper
Chicory
Chili
Coconut
Collard (greens)
Cucumber
Daikon
Eggplant
Endive
Fennel
Garlic
Gherkin
Habanera Pepper
Heart of Palm
Horse Radish
Jalapeno
Jicama
Kale
Kohlrabi
Leek
Lettuce
Mushrooms
Mustard
Okra
Olive
Onion
Palm Cabbage
Parsnips
Black-eyed Pea
Green Pea
Split Pea
Pimento
Potato (all except Sweet Potato)
Pumpkin
Radish
Safflower
Sesame
Shallot
Soy
Spinach
Squash (Hard shell)
Squash (soft skin varieties)
Sunflower
Sweet Potato (or North American Yam)
Tobasco
Taro
Tobacco
Tomato
Turnip
Watercress
Yucca
Zucchini

Fruits:

Apple
Apricot
Banana
Blackberry
Blueberry
Boysenberry
Cantaloupe
Casaba Melon
Cherry
Cranberry
Currant (Black or Red)
Date
Elderberry
Fig
Gooseberry
Grape
Grapefruit
Guava
Honey Dew Melon
Kiwi
Lemon
Lime
Litchi/Lychee
Loganberry
Mango
Mulberry
Muskmelon
Nectarine
Noni
Orange
Papaya
Peach
Pear
Persimmon
Pineapple
Plantain
Plum
Pomegranate
Prickly Pear
Prune
Quince
Rhubarb
Star Fruit
Strawberry
Tangerine
Watermelon
Youngberry

Spices/Seasonings:

Allspice
Anise (Aniseed)
Basil
Bay Leaves
Caraway
Cayenne
Chili Pepper
Chives
Cilantro
Cinnamon
Clove
Cumin
Dill
Ginger
Horehound
Juniper Berry
Licorice
Mace
Marjoram
Mint
Nutmeg
Oregano
Paprika
Peppercorns (black pepper, white, pink)
Peppermint
Poppy Seed
Rose Hips
Rosemary
Saffron
Sage
Sassafras
Savory
Spearmint
Tamarind
Thyme
Turmeric
Vanilla Bean
Wintergreen

Yeasts:

Baker's Yeast
Brewer's Yeast

Sweeteners:

Agave
Honey
Cane (sugar, molasses)
Maple (syrup, sugar)
Stevia

Miscellaneous:

Aloe Vera
Aspirin
Carob
Catnip
Cocoa (chocolate)
Codeine
Coffee
Cola Bean
Eucalyptus
Flax
Gardenia
Hibiscus
Lavender (not French Lavender)
Lilac
Morphine
Sesame
Tea (black tea, green tea, white tea)
Tea Tree Oil
White Willow Bark

Latex Allergy
Sulfate Allergy

Preferred Diet: Check the option for your preferred diet if allergies didn't apply.

Carnivore (meat eater)
Vegetarian (eggs/milk)
Vegan (only vegetables)

Please leave any notes, comments, questions, or any other allergens you'd like to add in the box below.


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**Please note: Personal Food Allergy profiles will not be completed until payment has been recieved. Thank you, for your patronage.