---
title: Allergy & Immunology Symptom Diary Form Template | Paperform
description: Free allergy symptom diary template with reaction severity tracking, allergen exposure logging, and epinephrine use monitoring for patients and healthcare providers.
url: "https://paperform.co/templates/allergy-immunology-symptom-diary"
type: static
generatedAt: "2026-03-28T00:43:01.141Z"
---

[← Back to free form templates](/templates/)    ![Allergy & Immunology Symptom Diary](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/allergy-immunology-symptom-diary.png)
    [Preview](https://_preview.paperform.co/ai-template/allergy-immunology-symptom-diary) [Use this template for free](/create?ai-template=allergy-immunology-symptom-diary)    [Surveys & Questionnaires](/templates/category/surveys/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Mental Health](/templates/industry/mental-health/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
Managing allergies and immunological conditions requires careful tracking of symptoms, triggers, and treatments. This **Allergy & Immunology Symptom Diary** helps patients document their daily experiences with allergic reactions, identify patterns in allergen exposure, and maintain accurate records for healthcare providers.

Whether you're managing food allergies, environmental sensitivities, or chronic immunological conditions, this symptom diary provides a structured way to record reaction severity, track potential triggers, and monitor medication usage including epinephrine administration. The detailed logs help allergists and immunologists make more informed treatment decisions and adjust management plans based on real-world data.

**Perfect for allergists, immunologists, primary care physicians, and patients** managing conditions like anaphylaxis, chronic urticaria, eczema, asthma, or multiple chemical sensitivities. This template captures everything from mild symptoms to severe reactions, creating a comprehensive picture of your allergy journey.

With Paperform, you can customize this symptom diary to match your specific practice needs, add conditional logic to show relevant follow-up questions based on symptom severity, and integrate submissions with your patient management system. You can even use **[Stepper](https://stepper.io)** to automatically route severe reactions to urgent care protocols or send regular symptom summaries to your clinical team.

The form includes a severity rating scale, detailed symptom checklists, allergen exposure tracking, medication logs, and space for photos or additional documentation. All data is securely collected and can be exported for clinical review, helping bridge the gap between patient experiences and professional care.
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