Allergy Questionnaire

If you suspect you may have allergies, consider the following questions:

1. Are you bothered by any of the following potential allergens?

  • Grass
  • Barns
  • Tree pollen
  • Weather changes
  • Ragweed
  • Dusty places
  • Wind
  • Moldy places
  • Dogs
  • Raking leaves
  • Cats
  • New buildings
  • Horses
  • Insect stings
  • Perfumes
  • Smoke
  • Pesticides
  • Medications
  • Cows

2. Have you experienced or are you experiencing any of the following symptoms?

  • Nasal symptoms (runny nose, congestion)
  • Ear symptoms (pressure, pain, itchiness)
  • Mouth and/or throat symptoms (post nasal drainage, sore throat, hoarseness, difficulty swallowing, itchiness)
  • Eye symptoms (itchiness, increased drainage, redness, puffiness)
  • Headaches
  • Breathing problems (shortness of breath, coughing, wheezing)
  • Stomach symptoms (acid reflex, nausea, diarrhea)
  • Skin problems (dryness, eczema)
  • Sleep problems (snoring, difficulty falling asleep)

3. Have you ever had a severe allergic reaction that required emergency care?

If you answered β€œyes” to any of these questions, contact us at (479) 750-2080 today to schedule an allergy test and/or develop a treatment plan.