Perioperative Allergy Network

Please complete this form if you would like to become a network member of the Perioperative Allergy Network. Please note that no prior experience of perioperative allergy is required to join the network. All grades and levels of seniority are welcome.

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* 1. Your title:

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* 2. Full Name:

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* 3. Email:

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* 4. What is your primary speciality?

Allergist

Immunologist

Anaesthetist

Dual-trained

Other (please specify)

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* 5. At what hospital or Trust do you work? (and if working for a Trust, how many sites does the Trust have?)

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* 6. If you are an allergist, immunologist, or anaesthetist working in the anaesthetic allergy clinic, which Trusts refer their patients to you for investigation of anaesthetic allergy?

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* 7. If you are an anaesthetist NOT working in the anaesthetic allergy clinic, which Trust do you refer your suspected anaesthetic allergy patients to for further investigation?

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* 8. Who do you treat in your clinic?

Adults

Children

Both

Thank you for your time. Please click on the 'Done' button to submit your responses.