Allergy information form template

About this allergy information form

An allergy information form tells schools, caterers, camps, employers and carers exactly what someone is allergic to, how they react, how severe it can be, which emergency medicine they carry (such as an adrenaline auto-injector) and step-by-step what to do in a reaction.

For severe allergies, ask your doctor to review the action plan section. Many doctors provide an official allergy action plan that should be attached.

What’s on the allergy information form

The template has 6 sections and 13 questions. Every one can be renamed, moved or deleted.

• Person: Name; Date of birth; Weight (for medicine dosing); Photo attached (yes or no)
• Allergies: Allergies table (Allergen, Reaction, Severity (mild / severe))
• Emergency medicine: Medicine (e.g. adrenaline auto-injector, antihistamine); Dose; Kept at; Expiry date
• If there is a reaction: Other instructions from doctor
• Contacts: Contacts table (Name, Relationship, Phone); Doctor and phone
• Signature: Parent, guardian or patient signature with date

Tips

• List the exact allergen (e.g. “peanuts and tree nuts”, not just “nuts”).
• Say where the emergency medicine is kept and check its expiry date.
• Share it with everyone who prepares food or supervises the person.

Four ways to save it

A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.