1. What symptoms are you experiencing? Hives or rash Itchy mouth or throat Vomiting or nausea Diarrhea or abdominal cramps Swelling (lips, face, tongue) Difficulty breathing / Anaphylaxis Eczema / skin irritation Sneezing / Runny nose Fatigue after eating

2. Which food(s) did you consume recently? Milk / Dairy Eggs Peanuts / Tree Nuts Shellfish / Fish Soy Wheat / Gluten Fruits (e.g. banana, apple, kiwi) Vegetables (e.g. tomato, celery) Spices (e.g. cinnamon, mustard) Food additives / preservatives