Which of these allergy symptoms do you experience?
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Runny Nose
Congestion
Excessive Sneezing
Itchy Eyes
Dry Eyes
Hives
Cough
Wheezing
What medications do you take to manage your allergies?
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Allergy immunotherapy shots or drops
Steroid nasal spray (e.g. Flonase, Nasacort, Nasonex, Rhinocort)
Oral antihistamines (e.g. Zyrtec, Allegra, Claritin, Xyzal, Benadryl)
Antihistamine nasal spray (e.g. Pataday/Patanol, Alaway, Zaditor)
Decongestant (e.g. Pseudoephedrine, Sudafed)
Afrin (Oxymetazoline)
Saline nasal sprays or rinses (e.g. Neti Pot, NeilMed)
I’m currently not taking any medication for my allergies
Other
Do you have any of the following pets at home?
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Dog
Cat
Bird
Guinea Pig
Rabbit
When do you experience your worst symptoms?
Early Spring
Late Spring/Summer
Fall
Year Round
Which symptoms do you suffer from the most?
Itchy/Watery Eyes
Congestion
Wheezing
Rate the severity of your symptoms on a scale from 1 to 5, 5 being the worst:
1
2
3
4
5
Have you ever tried immunotherapy?
Yes
No
I don't know
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First Name
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Last Name
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Cell Phone
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Email
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Yes