Food Allergy Questionnaire

Please answer the food allergy questionnaire (*indicates a required field)

The Terrace Hotels
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Accommodation
*Hotel

*Title

*Last Name

*First Name

*Phone

*E-Mail

*Please check your spelling before sending.
*Please add "@terrace.co.jp" to the safe list in order to receive emails from us.

*Check-in Date

 /   /   

*Number of Adults

*Number of Children (age 12 and under)

Information of person requesting hypoallergenic menu
*Title

*Last Name

*First Name

*Age

*Your allergy details
Those who have been diagnosed as allergic, please let us know your allergy symptoms and doctor's supervision.
If you have selected "may cause anaphylaxis reaction"

The year and month of your last reaction  / 

Please let us know the details of your food allergens
Those who have been diagnosed as allergic, please let us know your allergy symptoms and doctor's supervision.

What are your favorite ingredients?
What is your daily menu?

Your inquiry
Feel free to write about any other questions and concerns.

　

Guests who wish to request a hypoallergenic "special dietary menu"
are asked to make a final decision after reading the following essential considerations.

  1. Regarding 7 allergen sources for which labeling is required by Japanese Law, we will make every effort to prevent allergen penetration with advance request.
    Regarding 18 allergen sources for which labeling is recommended by Japanese Law, we may request you to bring your own meal.
  2. While our chefs make every effort to prevent allergen penetration during food handling and preparation, small levels of substances may unintentionally appear in meals as the kitchens, crockery and cutlery are used for both the regular menu dishes and the special dietary dishes.
  3. Washing facilities of crockery and cutlery are used for both special dietary dishes and regular menu dishes.
  4. We obtain the ingredients information of products through actual producers.
  5. We may ask you to bring your medical certificate depending on your allergy symptoms.
  6. After reviewing your completed questionnaire, there is a possibility that we may reach to a decision that we cannot meet your needs for allergy menu arrangements. If so, we may ask for your decision.
  7. If you require a particular food or seasonings which are not in our selection, we may ask you to bring them with you.


If you confirm the above, please click the "confirmation" button.

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