<<Disclaimer:  Verify this information before applying it to your situation.>>
 
                 Celiac-Friendly Restaurant Contacts
                 -----------------------------------
 
Hello,                                        DATE:___________________
 
Celiac Disease is a medical condition caused by an intolerance to
gluten.  It can be controlled with diet by avoiding ALL sources of
gluten.  Gluten is found in products made from wheat, barley, rye, and
oats.  Bread and pasta are some of the more obvious sources of gluten.
Soup bases, sauces, vinegars from the above grains (wine or cider are
okay), deep-frying oil, and condiments are sometimes not-so-obvious
sources of gluten.
 
To protect themselves, celiacs must know the source of all food
products and preparations.  Celiacs enjoy eating out, but they must
have information from a knowledgeable source at a restaurant as to
both how their food will be prepared and what the labeled contents are
of all products to be used in preparing their food.
 
We would like to add your restaurant to our support group's list of
celiac-friendly restaurants.  This list is used by our support group's
members, and would be shared with other support group members
throughout the country who may be visiting in our area.  To do so, we
would ask you to help us with the following information.
 
RESTAURANT NAME:______________________________________________________
 
ADDRESS:______________________________________________________________
 
PHONE NUMBER:_________________________________________________________
 
MANAGER - DAY:________________________________________________________
 
MANAGER - NIGHT:______________________________________________________
 
Do you currently have gluten-free meals available?       YES___  NO___
 
Would you be able to serve a gluten-free meal to a customer
                                              if asked?  YES___  NO___
 
To whom should celiacs talk with if they wish to dine here?
 
                NAME:_________________________________________________
       DAY
                TITLE:________________________________________________
 
                Before:____________ PM
 
                NAME:_________________________________________________
       NIGHT
                TITLE:________________________________________________
Should they talk to this person...
             before they come in to dine?  YES___  NO___
             when they come in to dine?  YES___  NO___
             both before and when they come in to dine?  YES___  NO___
 
Are there any suggestions you can offer for us to help you help us?
 
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