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Allergy Form 2024
Hello families! We are updating our records and would like to make sure we have allergy information up to date. Please fill out the below information as soon as possible.
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Client's Name
*
Your answer
Contact Phone Number
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Your answer
Please list allergies below:
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Your answer
Please list the of severity of the allergies. ( ex. epi pen, 911)
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Your answer
Please list any medical conditions we should know about. (ex. seizures, diabetes)
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Your answer
Please list current medication that your child is taking.
*
Your answer
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