Allergy Cork | Paediatric Allergy and pulmonology

Child's name *

DOB *

Address *

GP name and address *

Parent/guardian’s name *

Parent/guardian’s contact number *

Parent/guardian’s email address *

Please describe your child’s current compliant

Does your child suffer from:

Hayfever
Eczema
Asthma
Choice 5

Please note that

Third Choice

1. Prick/blood testing will only be performed at your doctor’s discretion, based on what is appropriate in the doctor’s expert opinion. Testing may not take place if the doctor feels this is inappropriate. 2. Initial Allergy Consultation total fee: €350 3. Payable: Deposit when booking:€200 (Please note: deposit is non refundable at cancellation) Balance at the clinic on the day of your appointment: €150 4. No antihistamines can be administered 7 days prior to the appointment 5. After filling out this form, the consultant needs to triage first after which you will receive a text/call from Allergy Cork asking you to contact us to arrange an appointment, this generally takes between 1 to 3 weeks (but on occasion might take longer) 6. By ticking the box underneath you give permission to store and process your data

Checkboxes *

I acknowledge the above and would like to book an appointment.
Choice 4

Please self-refer (request an appointment) here

Initial Paediatric Allergy Consultation

Hydrogen Breath Testing

For myself

For my child