International Oral Immunotherapy Inquiry Sheet

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Thank you for inquiring about treatment of food allergies with oral immunotherapy. Please fill this sheet out to help us get to know you a little better so we can formulate the best treatment plan for you or your loved ones.

Demographic information

Food Allergy History

A member of our staff will reach out to you once the inquiry is submitted to set up a consultation with Dr. Agrawal. If there are any additional records - such as copies of consultation notes, skin tests or blood tests – that you would like to share, you can email them to

Thank you again for thinking of Freedom Allergy to help with your food allergy needs!

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