Menu Modification Request Form

Lake County Food Services’ goal is to provide nutritious meals in a safe environment for all students of Lake County Schools, We understand that some children we serve have special dietary needs that may require a meal modification outside of USDA meal patterns.

Meal modifications for students with medical disabilities

We will make meal modifications for your child with a documented medical condition.

When requesting a meal modification for your child, Lake County Food Services Department requires a written medical statement from a Florida license medical professional (MD, PAS, ARNP, DO).

Below outlines what’s included in the statement.

Included in the medical statement

· The medical statement identifies the medical disability.

· How the disability restricts the child’s diet.

· Major life activity affected by disability.

· Foods to be omitted from child’s diet.

· Recommended food substitutions.

We require a “Meal Modification Form” or medical statement for children with food intolerances and food allergies that don’t result in life-threatening reactions.

A licensed medical professional must complete and sign the meal modification form or medical statement. Lake County Food Services Department will review the request on a case-by case basis.

Food Preferences

Lake County Schools Food Service Department does not make meal modifications for lifestyle or food preferences. Our menus offer a variety of selections.

Please Fax Medical Statements and/or Meal Modification Forms to 352-253-6801, scan to FoodServicesDept@lake.k12.fl.us, or you can personally drop off forms at our office at 201 W. Burleigh Blvd., Tavares , FL 32778.

Menu Modification Request Form

Discontinuation of Meal Modification Request