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Asheville Medicine and Pediatrics New Patient Medical HistoryPlease fill out all sections completely. PATIENT NAME: DATE OF BIRTH: Please list ALL medications you are currently taking. Be sure to

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What is are you allergic to?

I am allergic to peanuts.

Who is required to file are you allergic to?

Anyone with allergies should fill out an allergy form.

How to fill out are you allergic to?

You can fill out the allergy form by listing all the substances you are allergic to.

What is the purpose of are you allergic to?

The purpose of the allergy form is to inform others about your allergies so they can take necessary precautions.

What information must be reported on are you allergic to?

You must report all allergens that you are sensitive to on the allergy form.

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