• PATIENT ALLERGY HISTORY FOR DR. A. MASTROSIMONE

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  • You may also Scan or Attach Allergy-Testing results with this form.

  • Select or Check any of the following symptoms you have NOW or have had in the past

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  • Frequent sore throats:         
    Antibiotics prescribed Yes        
    How many times/yr.   

  • Cough

    (Choose or select all that applies)
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  • We do not support any claims to diagnose, treat, or cure any medical condition or disease.

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