Help us understand the severity of your allergies
To continue, please fill in or correct the fields marked with red text.
If you need help, call support at 1 (855) 632-6940
Which of the following symptoms do you suffer from?
* Field Cannot Be Left Blank
What triggers your symptoms?
* Field Cannot Be Left Blank
Please rate the severity of your symptoms.
* Field Cannot Be Left Blank
Approximately when did your symptoms start?
* Field Cannot Be Left Blank
Which of the following apply to you?
* Field Cannot Be Left Blank
Which of the following apply to you?
* Field Cannot Be Left Blank
Tell us a little more about you
Have you had nasal surgery (including sinus surgery, septoplasty, rhinoplasty, polyp surgery, and turbinate surgery) in the past 3 months?
* Field Cannot Be Left Blank
Have you been diagnosed with allergic rhinitis or seasonal/environmental allergies by a healthcare provider?
* Field Cannot Be Left Blank
Let's find the right treatment for you
Do you already know which medications work well to treat your allergies? If yes, please list the medications, how long you have used them for, and if you are still currently using them.
* Field Cannot Be Left Blank
Is there anything else related to treatment that you'd like to ask or discuss with your medical provider?
Do you have a preferred medication?
* Field Cannot Be Left Blank
Would you like to share anything else with your provider through an upload?