Alex Test | Allergy testing

ALEX 3 Symptom Questionnaire

This questionnaire is intended for patients who are willing to have ALEX 3 test done in our clinic.

First Name (patient)*
Last Name (patient)*
Gender (patient)*
- Male
- Female
Date of Birth (patient)*
DD slash MM slash YYYY
Email*
Enter Email Confirm Email
Phone*
Address (for delivery of the testing kit)*
Address City Post code Country
Please describe your main symptoms or concerns and explain why you are ordering an allergy test.*
I give consent for the use of anonymised information from this questionnaire and test results for teaching, audit and research purposes. This is a required field.*
- Agreed
Payment and sample collection*
- Agree to have a fingerprick allergy test done
Once payment has been made via our secure Worldpay system, your testing kit will be dispatched to your home address. You will receive instructions explaining how to collect your sample using a finger-prick method and post it to the laboratory. If you are not comfortable collecting your own sample, please do not proceed with payment. Instead, contact our office at info@ukallergy.com , and we will be happy to discuss alternative arrangements with you. For children, samples must be collected by a healthcare professional. By proceeding, you confirm that you agree to our refund policy and communication policy. If you feel unsure about taking your own sample, please book an appointment with an allergy consultant.
Allergy Test Payment*
Price: