SECTION 1
This section is for the CHILD to complete.
Please remember that these questions are about your allergies. If you are not sure how to answer a question, please ask your parent or carer for help.
1. What condition do you have? (Tick more than one if you need to):
Asthma (wheezing, chest coughs)
Hayfever or Rhinitis (itchy runny nose or eyes, sneezing)
Eczema (itchy / red skin)
Food Allergy (vomiting, tummy ache)
Don't know / Can't remember
Other:
2. How long have you had any allergic symptoms? Please ask your parent or carer if you are not sure:
For less than one year
For over one year
Since I was a small baby
Don't know / Can't remember
Still thinking about this most recent person you saw for your allergy...
6. Overall, how well do you think you were looked after by this person?
MANAGING YOUR CONDITION
Treatment & Medication
7. Do you use any medication for your condition (such as medicines, tablets, creams, inhalers and/or injectors)? Please ask your parent or carer if you are not sure:
8. Do you have enough information about when you should use your medicines or creams (for example at what time of day and how often)?
9. Do you know how to use your medicines or creams (for example how to put on your cream or take your tablets or use your injector)?
10. Have health professionals told you about the side effects of the medicines or creams to watch for? Please ask your parent or carer if you are not sure:
Yes, definitely
Yes, sort of
No
This is not needed
16. Do you have a say in how your condition is looked after?
17. Do you have information about support groups for your condition (such as Allergy UK, Asthma UK; Anaphylaxis Campaign; National Eczema Society)? Please ask your parent or carer if you are not sure:
Yes, enough information
Some but not enough information
None, but I would like this
I do not want or need this
18. Overall, do you have enough information about your allergic condition(s)?
19. Overall, how well do you think your condition is looked after by healthcare staff (doctors and nurses)? Please tick ONE only based on your overall allergy care:
AND FINALLY . . .
20. Who was the main person who answered the questions in this section of the questionnaire?
The young person who has the allergy
The parent or carer of the child
Both parent and child together
21. Are you a boy or a girl?
Please now ask your PARENT OR CARER to answer the questions in Section 2.
SECTION 2 (PARENTS)
This section is for your PARENT or CARER to complete.
Please encourage your child to help answer these questions if they are able.
INITIAL RECOGNITION
23. How many times did you see a health professional about your child's first allergy symptoms before they were given a firm diagnosis?
My child has not yet received a firm diagnosis
Between 2 and 3 times
Between 4 and 6 times
7 times or more
Don't know / Can't remember
24. From when you first saw a health professional about your child's condition, how long did you wait for tests to be carried out (to confirm what causes their condition or makes it worse)?
They were done straight away
Less than 1 month
Between 1 month and 3 months
Between 3 months and 6 months
More than 6 months
They are still waiting to have tests
Don't know / Can't remember
MANAGING YOUR CHILD'SCONDITION
Personal Management Plans
A personal management plan is a written plan agreed between yourself/ your child and a doctor or nurse to help manage their allergic condition(s)
29. Do you and your child have a personal management plan for their condition? Please read the description in the box above if you are not sure what this is:
30. Does your child's school or nursery know about their personal management plan?
Yes
No
Don't know
This is not necessary / my child does not go to school or nursery
31. Do you and your child follow their personal management plan?
Yes, definitely
Yes, to some extent
No
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YOUR MOST RECENT ALLERGY CARE
Thinking about your most recent allergy care (such as at the doctors / in hospital / by ambulance staff)...
3. Who was the most recent person you saw about your allergy? If you saw more than one person, please select the MAIN person that you saw. Please ask your parent or carer if you are not sure:
Specialist allergy staff (e.g. clinic staff/specialist hospital doctor)
Family doctor or nurse at the doctor surgery (GP)
Emergency hospital staff (ambulance staff/paramedics; A&E staff)
Urgent care centre staff (doctor or nurse)
General children's doctor / paediatrician (not an allergy specialist)
Dietitian
Urgent care centre staff (doctor or nurse)
Other:
4. Did this person talk to you in a way that you could understand?
5. Did this person answer your questions in a way you could understand?
I did not have any questions
I did not have a chance to ask
Yes, definitely
Yes, sort of
No
11. Have you ever been given any emergency treatment (such as an injection, oxygen or medicine) by healthcare staff?
12. Did staff give you enough information about this emergency treatment?
13. Do you carry an injector for your condition (e.g. EpiPen / Anapen / Jext)? Please ask your parent or carer if you are not sure:
Yes
No
Don't know/cant remember
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ONGOING CARE
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14. How do you feel about how often you have an allergy review or check-up (for example an appointment with your GP or at an allergy clinic)?
15. Do you know enough about the things that make your allergy worse (such as food, dust, pets)?
I know enough
I know some but not enough
I do not know enough
22. How old are you?
years old
ANYTHING ELSE TO SAY?
Is there anything that you think is really good about your allergy care? 
Is there anything about your allergy care that could be better or anything else that you need? 
RECENT ALLERGY CARE
Thinking about your child's most recent healthcare for their allergy (e.g. GP visit / hospital care / ambulance)...
25. Who was the most recent person your child saw about their allergy? (Tick ONE only). If they saw more than one person, please select the MAIN person that they saw:
Specialist allergy staff (e.g. clinic staff/ specialist hospital doctor)
GP / family doctor / practice nurse
Emergency hospital staff (ambulance staff/ paramedics; A&E staff)
Urgent care centre staff (e.g. doctor, nurse)
General paediatrician (not an allergy specialist)
Dietitian
Other
26. Were you given a chance to discuss your child's treatment (including medication options and avoidance advice)?
Yes, definitely
Yes, to some extent
No
It was not necessary
27. Did you feel that this healthcare professional knew enough about your child's allergic condition?
Yes, definitely
Yes, to some extent
No
They did not know what the allergy was
28. Did you have confidence and trust in this member of staff?
Yes, definitely
Yes, to some extent
No
Ongoing Care
32. Do health professionals (e.g. doctors and nurses) communicate with your child's school or nursery about their condition?
Yes, definitely
Yes, to some extent
No
Don't know
This is not necessary / they do not go to school or nursery
33. Do health professionals communicate with each other about your child's condition?
Yes, all or most of them do
Some of them do
No, very few or none of them do
We only see one health professional
Don�t know
34. Do you have the phone number of a doctor or nurse who you can contact about your child's condition?
Yes, during working hours only
Yes, out of hours only
Yes, at any time
No, I do not have a phone number
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