Alleviate Allergy Clinic logo Alleviate Allergy Clinic The Food Allergy Nurse Practitioner
Secure patient intake

In an emergency, call 911. This form is not monitored in real time and cannot be used for urgent medical needs. If you or your child are experiencing a severe allergic reaction, use epinephrine right away and call 911 or go to the nearest emergency department.

New patient intake

Welcome to Alleviate Allergy Clinic

We’re so glad you’re here. This guided intake takes about 10–15 minutes and gives us the full picture of your family’s story — symptoms, foods of concern, health history, and what you’re hoping for — so Alleviate Allergy Clinic can review it and recommend your best next step.

1. Share your storySix short sections about the patient, foods of concern, reactions, and health history.
2. Review & signRead the consents, add your initials, and sign electronically.
3. Pay & submitPay the $50 review fee on the final step, then press Submit to send it to the clinic.
$50
Practice Match Review fee — collected on the final step, right before you submit

Your completed intake is the Practice Match Review: we review every answer, confirm the practice is the right fit, and reach out with a recommendation. Paid once by secure online checkout (credit, debit, HSA & FSA cards) and credited toward your first care option if you begin care within 30 days. Care fees are billed at the time of care.

Your answers stay on this device until you press Submit and are never stored in your browser, so please finish in one sitting. Questions before you begin? Email [email protected].