Laboratory form | Allergy testing

Remote UKallergy: ALEX³ Test Order Form, Symptom Questionnaire and Card Payment

Please complete this questionnaire based on your own personal experience and current symptoms. To help our consultants interpret your results accurately, we ask that you describe your own experience rather than referring to previous test results or diagnoses. (If you are completing this form on behalf of a child or a relative, please provide their details and experiences in the sections below.) When you receive your results, you can book an appointment with an allergy consultant through our electronic health record system. Please click HERE to register for an account at ukallergy.carebit.co (opens in a new tab). This will allow you to access your results and book a consultation to discuss them if required. If you need any help please contact our custormer support by email.

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: