Take the Allergy Questionnaire

Do you suffer from allergies?

This Allergy Questionnaire lists symptoms and other factors most commonly found in people suffering from some form of allergy. Read each question carefully and check the box if it applies to you. When you finish, the form will automatically calculate your score.

Do you have fatigue?

Do you have frequent headaches?

Do you have sneezing, post nasal drainage or itching of the nose?

Do you have frequent colds?

Do you experience dizziness?

Do you get sinus infections every year?

Do your eyes itch, water, get red or swell?

Do you have recurrent ear infections?

Do you have asthma, wheezing, tightness in the chest or chronic cough?

Do you have skin problems such as eczema, skin rashes, itching or hives?

Do you have indigestion, bloating, diarrhea or constipation?

Do your symptoms worsen during a particular season, such as the spring or fall?

Do your symptoms change when you go indoors or outdoors?

Are your symptoms worse in parks or grassy areas?

Are your symptoms worse in the bedroom after going to bed, or in the morning upon arising?

Do you awaken in the middle of the night with congestion?

Are your symptoms worse when you come into contact with dust?

Are your symptoms worse around animals?

Do you have any blood relatives with allergies?

Do you have mood swings or feel depressed for no reason?

Do you have recurrent yeast infections, jock itch, Athlete’s foot or fungus under your toenails?

Do you develop symptoms after eating or drinking certain foods?

Do you sometimes feel stimulated, hyperactive or fatigued after meals?

Do you have dark circles under your eyes?

Do you have a crease across the bridge of your nose?

Total Score

 
Scoring Results:

• < 9 — It is not likely that you have allergies.
• 9-12 — Possibility of allergies.
• 13-30 — Allergies are probable.
• > 30 — Allergies are very likely.

 
For more personalized information, please request your FREE consultation here on Allergy Testing, or call us at 281-698-7435.

Feel free to read some testimonials from happy clients or find out more on why Dr. Shel is the go-to expert on Mind, Body & Spirit wellness.

Have a question? Ask us below!

1. Name(required)
2. Email(valid email required)
3. Phone Number(required)
4. Comments
5. Verification Code

 

cforms contact form by delicious:days