Allergies

Do you have a history of hay fever, asthma, eczema, allergies or rashes?

Are you allergic to any foods, especially bananas, avocados, kiwi or chestnuts? Do you experience rash, oral itching, swelling or wheezing when exposed to these foods?

Occupation

Are you exposed to any products that contain latex, including gloves, at work?

Have you ever had an allergic reaction to something in your work environment?

If you have had a rash on your hands after wearing latex gloves, how long after putting on the gloves did the rash develop?

What did the rash look like?

Hidden reactions to latex

Have you ever had swelling, itching, hives, shortness of breath, cough or other allergic symptoms during or after blowing up a balloon, undergoing a dental procedure, using condoms or diaphragms, or following a vaginal or rectal examination?

Have you ever had an allergic reaction of unknown cause, especially during a medical or dental procedure?

Surgical history

Have you ever had surgery? If so, what kind?

Do you have spina bifida or any urinary tract problem requiring surgery or catheterizations?