NY Food Allergy & Wellness - We welcome you!
Welcome to New York Food Allergy & Wellness where we strive for food allergy freedom!

We are excited to welcome you to our new ParkSixty office in Manhattan. Please provide your basic information below and our food allergy care-coordinator will be in touch with you.

We will join you at wherever stage of food allergy journey you are at and will travel with you to move towards more freedom.

Dr. Atul Shah and our team have been helping food allergy families for 20+ years. We have helped more than 15,000 food allergy families and you can learn more about our prior success at NYFoodAllergy.com and on YouTube at AmazingAllergist link.

New York City Location - Google Map Link: https://goo.gl/maps/XZ9ej3sKZGny25LU6

NY Food Allergy & Wellness
ParkSixty Medical
110 East 60th Street, Suite 708
New York, NY 10022

Phone: (212) 301-7636
Sign in to Google to save your progress. Learn more
Email *
Patient's First Name   -  Last Name  - DOB  - M/F *
Parents / Guardian Information *
Contact Information - Phone, Additional email (if any)  *
Whom do we thank for referring you to us? *
Food Allergy Summary - History and Concerns (Foods, types of reactions, prior skin tests, blood tests, component tests, BAT, prior food challenges, prior OIT/SLIT/Patch) *
Your purpose of NY Food Allergy Consultation - (comprehensive diagnosis, skin tests, blood tests, component tests, BAT, oral food challenges, long term food allergy freedom plan) *
Please list desired long term food allergy freedom goals and interests. (It is POSSIBLE at NY Food Allergy & Wellness, now, in Manhattan!)

(For Example: Protection against accidental reactions, bite-proof freedom, Free-eating)

1. Food Oral Challenges
2. Food SLIT (Sublingual Immunotherapy)
3. Food OIT (Oral Immunotherapy)
4. Biologics + OIT
5. Combination of 1, 2, 3, 4
 *
Other Needs - please list
(Food related anxiety, FPIES, EoE, Gluten Sensitivity, Lactose Intolerance, Fresh fruit - pollen allergy, Alpha-gal Red Meat Allergy, Seasonal Allergy, Asthma, Eczema)
 *
How soon do you want to be seen? 
(List days and times preferred based on your availibility) 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms