Question 1/19

Do you carry an EPI pen (Epinephrine Injection kit) for safety?

Question 2/19

What allergy/allergies do you suffer from?

Question 3/19

Do you have a medical alert bracelet?

Question 4/19

Any food allergies?

Question 6/19

Are you currently satisfied with your treatment?

Question 7/19

Please explain why are you dissatisfied with your current treatment

Question 8/19

Are you interested in changing your treatment?

Question 9/19

What treatment(s) are you interested in switching to

Question 10/19

Do you use any of the following natural remedies to treat your allergies?

Question 11/19

Do you get dry eyes from your allergies?

Yes, allergy related
No, not allergy related Invalid Input

Question 12/19

What do you use to treat your dry eyes?

RX Eye Drops
OTC Eye Drops

Question 13/19

What brand of RX Eye Drops?

Question 14/19

What brand of OTC Eye Drops?

Question 15/19

Do your kids have allergies too?

Yes
No
Not sure

Question 16/19

Do you currently have medical insurance?

Question 17/19

Please select your current medical provider

Question 18/19

What is the name of your provider?

Question 19/19

lease select the current medical coverage you have