• New Patient Questionnaire

  • Before making an appointment we ask you to provide us with some background information. This will provide us with details on your current and past conditions, assist us in aligning you with the right specialist for your needs, and allow us to be more familiar with you upon your first visit with us.

    This will only take you a few minutes. Once completed, our reception team will call you within 5 days to book an appointment.

  • Date of Birth*
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    2 digit day, 2 digit month, 4 digit year
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  • Medical Insurance*

  • Would you like your consult letters to be sent to your General Practice?*
  • Have you had Allergy Tests before?*
  • Have you had immunotherapy (desensitisation) before?*
  • Have you ever had a severe reaction to a Bee or Wasp sting?*
  • Have you ever had an Anaphylactic Reaction?*
  • Is your condition seasonal?*
  • Do you suffer any of these conditions?*
    Rows
  • Contact Allergy*
    Rows
  • Did you suffer from any of these conditions during childhood?*
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  • Have any of your first degree relatives had Asthma?*
  • Have any of your first degree relatives had Eczema?*
  • Have any of your first degree relatives had Rhinitis (Hay Fever)?*
  • Do you suspect any foods as causing symptoms?*
  • Are you omitting any food(s) at present?*
  • Environmental History*
    Rows
  • Are you sensitive or allergic to any Drugs?*
  • Are your symptoms brought on or worsened by exercise?*
  • General Medical History*
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  • Should be Empty: