Food Allergy Information Form | New Sunpia Saitama Ogose

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Allergy Pre-Inquiry Form

This is intended to ensure food safety for guests with food allergies who are staying at the hotel and consuming food and beverages.
It will not be used for any other purpose whatsoever.

We will take the utmost care in preparing your meal, but we ask that you use your own judgment when deciding whether to consume it.

Date of use*

Month

Day

Year

Plan Name*

Name of the person making the reservation [Group name]*

Name of person with allergies*

Age of person with allergies*

Gender of Individual with Allergies*

Male

Female

Contact phone number (Phone)*

1. Types of Food Allergies*

Egg

Milk

Wheat

Buckwheat

Peanut

Walnut

Shrimp

Crab

Other [Please fill in the field below]:

Other

2. Types of Food Allergies*

① Mild (Okay as long as it's not the ingredient itself; processed foods are acceptable.)

② Moderate (OK if used as a binder or ingredient.)

③ Severe (The ingredient must be completely removed from all food.)

④ Most Severe (All cooking utensils and equipment must be used, and the food must be prepared separately to avoid cross-contamination.)

3. What happens if I accidentally ingest it?*

① Minor injuries (no particular changes in the past)

② Moderate symptoms (past mild hives, etc.)

③ Severe (has experienced difficulty breathing in the past)

④ Most severe case (has been transported to the hospital by ambulance in the past)

*Please contact us if you require options ③ or ④.

(Please contact us if you require options ③ or ④)

350-0401
700 Furuike, Ogose, Iruma Saitama
TEL: 049-292-6111
FAX: 049-292-6113

JP: info@sunpiaresort.com

EN: sales@sunpiaresort.com

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