Allergy & Immunology Intake Form

The Allergy & Immunology Intake Form is specifically designed for allergists, immunologists, and allergy testing clinics. It captures the detailed allergy and immune system information these specialists need: comprehensive allergy history organized by category (food, drug, environmental, insect), reaction descriptions with severity grading, trigger identification, and the impact of allergies on daily life.

The environmental trigger section covers seasonal patterns, indoor allergens (dust mites, mold, pet dander), and occupational exposures. Patients document when symptoms are worst, what provides relief, and what they have already tried. Previous allergy testing results (skin prick, blood panels, challenge tests) are recorded with dates and findings.

The immunodeficiency screening section identifies patients who may need further workup for primary or secondary immune disorders, asking about recurrent infections, autoimmune conditions, and family immune history. Medication and immunotherapy history documents current and past allergy treatments including antihistamines, nasal sprays, inhalers, epinephrine auto-injectors, and allergy shot protocols.