Individual or Business
Include main dish, sides, appetizers, drinks, desserts, dips/dressings, and any individual preferences you requested.
e.g., Taste, Color, Texture, Flavor, Temperature
Other Possible Non-Food Exposures within Past 2 Weeks:
e.g., Roadside spring, fountain in park, 5k run water station
e.g., Swimming in pool, floating the river, water skiing at lake
This section is to be used to collect information about what the consumer ate and drank in the 72-hour period prior to the complaint.
This field is not part of the form submission.
* indicates a required field