Questions Related to Allergy

In order to prescribe treatments for Allergy our doctor needs some information regarding this specific condition. Please complete the following as accurately as possible.

Are you knowingly allergic to the treatment you are wishing to obtain or any of its ingredients?

Yes No

Have you taken the medicine you wish to obtain before?

Yes No

To date, have you ever taken or used any other antihistamines to manage your allergy symptoms?

Yes No

Do you suffer from liver or kidney disease?

Yes No

Are you pregnant, trying to conceive or breast-feeding or will you be while taking treatment?

Yes No

Please confirm that you understand that antihistamines may cause drowsiness in some patients and thus impair the ability to drive or operate machinery safely.

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