| Name: | |
| Email Address: | |
| Phone # (optional): | |
| Please list the allergy or allergies you resolved using the Allergy Resolution Process (e.g., wheat, pollen, cat dander…). |
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| What were your symptoms (e.g., scratchy throat, runny nose…)? |
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| On a scale of 1 to 10 (10 being the worst possible reaction), how severe were the symptoms you resolved? (e.g., wheat was an 8, pollen was a 6…) |
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| After resolving the allergy or allergies, using the same scale, what level are your symptoms now, if any? (e.g., wheat is now 0, pollen maybe a 1…) |
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| Are you happy with the results? Do you have any suggestions for improvement? Would you recommend the Allergy Resolution Process to others? |
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| Any additional thoughts or comments? |
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