Screening Questionnaire for Latex Sensitivity
3. Have you ever tested positive for latex allergy and/or Yes No. been told by a doctor that you have a latex allergy? 4. Have you had multiple childhood surgeries? Yes No. If yes, how many? _____ Do you suffer from: Seasonal hay fever? Yes No. Asthma? Yes No. Eczema? Yes No 6. Do you have on-the-job exposure to latex? Yes No. 7. ................
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