ALK

Fight the Cause of Allergies Survey
RequiredRequired Question(s)

Thank you for your interest in the Fight the Cause Campaign!  We look forward to partnering with you.  Together we can increase the number of allergic patients who get properly diagnosed and treated by allergy specialists. 

 
Required 1.

Please enter the information indicated below.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

What % of your patients are tested for allergies on the initial consult?
Less than 35%
35 - 50%
50 - 75%
Greater than 75%
Required 3.

What is the estimated number of patients on Immunotherapy in your practice?

Less than 150
150 - 300
300 - 500
500 - 1,000
Greater than 1,000
Required 4.

What would have the most impact in getting your practice to put more patients on immunotherapy?

(1 = Most Important)
 
Provide allergy educational materials for patients
Provide non-allergists with educational materials for more referrals or the right type of referral.
Improve the dosing of immunotherapy with major allergen data
Provide off the shelf treatment sets (reducing turnaround and cost)
Other (Please Specify)
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