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Perioperative Allergy Network

Please complete this form if you would like to become a network member of the Perioperative Allergy Network and you will be added to the mailing list. Please note that no prior experience of perioperative allergy is required to join the network. All grades and levels of seniority are welcome.
1.Your Title
2.Full Name
3.Email
4.What is your primary speciality?
5.At what hospital or Trust do you work? (and if working for a Trust, how many sites does the Trust have?)(Required.)
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?
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?
8.Who do you treat in your clinic?(Required.)