Accommodating Food Allergies
For guests with food allergies, we will endeavor to accommodate your needs to the best ofour ability if the notification is submitted at least three days prior to your arrival date.
In such cases, we request that you submit the Pre-Stay Questionnaire Regarding FoodAllergies, which we will provide you, to review how we can accommodate your requirements.
We will strive to eliminate individual allergens, such as shrimp for shrimp allergies, to thebest of our ability. However, we may not be able to accommodate all allergens as flour, soy,and other ingredients may be contained in condiments, making it more challenging to isolate
and eliminate individually.
Moreover, sensitivity to allergens varies by individual. While we may be able to eliminate
certain food ingredients, we will not be able to completely eliminate trace amounts that may
be present on cookware used for hotpots and other dishes.
Due to the operational constraints of our ryokan (traditional inn), it may be challenging for
us to fully accommodate your requirements, and therefore, we cannot assume responsibility
for your food allergies. For your safety, if you have severe allergies, please consult with yourphysician in advance.
Chef Yshiharu EbikoPre-Stay Questionnaire Regarding Food Allergies（If there are multiple guests with allergies within the same group, please ﬁll out one form

Otaru-kourakuen

for each guest. ）This questionnaire is to inquire about food allergies and does not apply to food preferences. Due to the operational constraints ofour ryokan (traditional inn), it may be challenging for us to fully accommodate your requirements, and therefore, we cannot
assume responsibility for your food allergies. For your safety, if you have severe allergies, please consult with your physician inadvance. We may need to follow up with you, so please make sure to provide your contact information. Please submit the form
three days prior to your arrival date.

□ Male □ Woman Age

Name

TEL

e-mailArrival date
Number ofFAX

nights①、Are you currently diagnosed with food allergies by a physician and receiving treatment?

□ I am receiving treatment regularly.

□ I have not received treatment in over a year.

②Please specify the food you are allergic to, tick oﬀ the food types that trigger reactions, and provide additional notes wherenecessary.
Food item

Ingre-Process-dientsed foods✔

✔

e.g.) Shellfish allergy

Binders Extracts

Additional notes

Level of severity

Severe Moderate Low✔

✔

I experience severe reactions to crabs in particular.

③Have you had an anaphylactic reaction in the past?

□ Yes

□ No

④Are you prescribed with an epinephrine?

□ Yes

□ No

⑤If you have additional concerns, please provide detailed information, such as speciﬁc allergens and requirements.

This questionnaire serves as a reference to ensure food safety for guests with food allergies who will be staying and dining atour establishment. This document will not be utilized for any other purposes. Additionally, this questionnaire will be stored anddisposed of under our responsibility with consideration for your personal information. If you agree to the above statement
regarding the handling of personal information, please provide your signature and submit this form.
Signature

DateSend this form to：E-mail / otaru-kourakuen@key.ocn.ne.jp
Fax / 0134-54-8223