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___
