nUT/pEANUT sURVEY 4 sCIENCE pROJECT

Posted on: Sat, 01/05/2002 - 3:07am
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Joined: 01/03/2002 - 09:00

Nut/Peanut Allergy Question
HERE'S THE SURVEY SO YOU CAN FILL IT OUT AND PUT IT ON HERE BECAUSE THE SITE NOTIFIES ME WHEN SOMEONE HAS REPLIED

1. Are you a male or female?

2. How old are you?

3. Are you allergic to nuts, peanuts or both?

4. Do you have any other allergies? Yes____ No____

5. If the answer to #4 is Yes, list other things you are allergic to.

6. At what age did you discover that you had a nut and/or peanut allergy? _____

7. How did you first find out you had a nut/peanut allergy?
____ a reaction to the nut/peanut ____ allergy test

8. Did your mother smoke when she was pregnant with you? Yes___ No____

9. Does anyone in your immediate family have nut/peanut allergies? Yes__ No__

10. If you answered Yes to #9, who is allergic and what are they allergic to?

11. Does any one in your immediate family have other allergies? Yes___ No___

12. If you answered Yes to #11, who is allergic and what are they allergic to?

13. Does anyone in your extended family have a nut/peanut allergy? Yes__ No__

14. If you answered Yes to #13, who is allergic and what are they allergic to?

15. Does anyone in your extended family have other allergies? Yes___ No___

16. If you answered Yes to #15, who is allergic and what are they allergic to?

17. Do you have asthma? Yes___ No___

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