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patient questionnaire

This questionnaire should give a first indication if an allergic respiratory disease like allergic hay-fever could exist. The completion of the questionnaire will take about 5 minutes and will calculate the probability of a possible allergic disease.

Progress

How do your eye complaints become apparent?

How do your respiratory complaints become apparent?

How do your nasal complaints become apparent?

How do your skin complaints become apparent?

What leads to an improvement of your complaints?

Do you own pets or do you have frequent contact with pets?

Did complaints become apparent when in contact with pets?

Was an allergy test or allergy treatment carried out in the past?

At what time of the year do the complaints occur?

At what time of day do the complaints occur?

During which weather conditions do the complaints occur?

During which activities do the complaints occur?

Do you have food-related complaints?

Do complaints occur after insect stings/bites?

drug hypersensitivity

Where do the complaints occur?

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