Keeping a record of all of your allergies is an important and simple self-care step. Simply forgetting your one-time reaction to a medication could one day cause very serious complications. Consider filling one out for your children as well and keeping the information in your wallet, just in case healthworkers need the information and your condition doesn't allow you to communicate.

If you have allergies, Please fill in this table.

Drug or Food, dye etc..


( Star (*) those you were told to avoid)

Request a Refill

4 + 3 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.