Insect Sting Allergy Risk Survey

1. Have you ever been stung by an insect (e.g., bee, wasp, hornet)? Yes No

2. Did you experience any of the following after a sting? (Check all that apply) Swelling beyond the sting site
Hives or rash
Difficulty breathing
Dizziness or fainting
None of the above

3. Do you have a known allergy to insect stings? Yes No

4. Have you ever needed emergency treatment after an insect sting? Yes No

5. Do you carry an epinephrine auto-injector (EpiPen)? Yes No

6. Do you have a family history of insect sting allergies? Yes No

Additional Comments