FOOD ALLERGY INSTITUTE (“FAI”) TOLERANCE INDUCTION PROGRAM Medical History Questionnaire

FAI Medical History Questionnaire

This form gives our team insight into your child’s medical background so we can customize the plan safely and effectively.

• Be thorough when answering questions about past and current medical issues.

• As with the other forms, enter the patient’s full name and main contact email to ensure proper linkage.

• The form can be revisited at any time via the “Forms” menu or the password link emailed to you.