---
title: Chronic Urticaria Assessment Form Template - Track Hives & Triggers | Paperform
description: Professional chronic urticaria assessment form for healthcare providers. Track hives frequency, identify triggers, monitor antihistamine response, and prepare for allergist consultations with this comprehensive template.
url: "https://paperform.co/templates/chronic-urticaria-assessment-form"
type: static
generatedAt: "2026-03-28T00:43:19.252Z"
---

[← Back to free form templates](/templates/)    ![Chronic Urticaria Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/chronic-urticaria-assessment-form.png)
    [Preview](https://_preview.paperform.co/ai-template/chronic-urticaria-assessment-form) [Use this template for free](/create?ai-template=chronic-urticaria-assessment-form)    [Surveys & Questionnaires](/templates/category/surveys/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Consulting](/templates/industry/consulting/)[Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
Managing chronic urticaria (chronic hives) requires detailed tracking and assessment to identify patterns, triggers, and treatment effectiveness. This **Chronic Urticaria Assessment Form** template helps healthcare providers, allergists, and dermatology clinics gather comprehensive patient information about hives frequency, severity, potential triggers, and medication response.

Whether you're running an allergy clinic, dermatology practice, or immunology center, this form streamlines the intake process by capturing essential data about urticaria episodes, quality of life impact, and previous treatment attempts. The structured format ensures you collect all the information needed for accurate diagnosis and personalized treatment planning.

**Built for healthcare teams that need to:**

 - Track hives frequency, duration, and severity patterns over time
 - Identify potential triggers including foods, medications, environmental factors, and stress
 - Monitor antihistamine response and previous treatment efficacy
 - Document angioedema episodes and associated symptoms
 - Assess quality of life impact and functional limitations
 - Prepare comprehensive data for allergist or specialist consultations

With Paperform's conditional logic, the form adapts based on patient responses—showing relevant follow-up questions about specific triggers, medication side effects, or emergency episodes only when needed. You can embed this form directly into your patient portal, share it via email before appointments, or use it as part of telehealth consultations.

Once submitted, responses can flow directly into your EHR system via [Stepper](https://stepper.io) workflows, trigger appointment scheduling confirmations, or generate follow-up task lists for your clinical team. For practices using Papersign, you can automatically generate and send consent forms for allergy testing or specialized treatments based on the assessment findings.

This template is ideal for allergists, dermatologists, immunologists, primary care physicians, and healthcare clinics focused on delivering thorough, patient-centered care for chronic urticaria management.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Autoimmune Disease Symptom Tracker](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/autoimmune-disease-symptom-tracker.png)

### Autoimmune Disease Symptom Tracker

A comprehensive pre-visit symptom assessment form for tracking autoimmune disease symptoms, identifying flare patterns, and monitoring medication side effects across multiple organ systems.](/templates/autoimmune-disease-symptom-tracker/)
[![Chronic Disease Self-Management Assessment](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/chronic-disease-self-management-assessment.png)

### Chronic Disease Self-Management Assessment

A comprehensive assessment form for patients managing chronic conditions, featuring goal-setting exercises, barrier identification, and personalized care plan agreements to support better health outcomes.](/templates/chronic-disease-self-management-assessment/)
[![Chronic Idiopathic Urticaria Assessment & Hives Diary](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/chronic-idiopathic-urticaria-assessment-hives-diary.png)

### Chronic Idiopathic Urticaria Assessment & Hives Diary

A comprehensive assessment form for chronic hives with symptom tracking, trigger identification, autoimmune screening, and specialist referral recommendations.](/templates/chronic-idiopathic-urticaria-assessment-hives-diary/)
[![Diabetes Risk Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/diabetes-risk-assessment-form.png)

### Diabetes Risk Assessment Form

A comprehensive diabetes risk assessment tool that evaluates family history, lifestyle factors, and BMI to identify high-risk patients and provide appropriate referral pathways.](/templates/diabetes-risk-assessment-form/)
[![Direct Primary Care Membership Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/direct-primary-care-membership-intake-form.png)

### Direct Primary Care Membership Intake Form

Streamline new patient enrollment for direct primary care practices with membership benefits, pricing transparency, and specialist coordination details.](/templates/direct-primary-care-membership-intake-form/)
[![Heart Failure Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/heart-failure-screening-questionnaire.png)

### Heart Failure Screening Questionnaire

Comprehensive heart failure screening form with dyspnea assessment, edema tracking, BNP lab ordering capabilities, and automated cardiology referral criteria for early detection and intervention.](/templates/heart-failure-screening-questionnaire/)
[![Hematology Bleeding Disorder Screening Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hematology-bleeding-disorder-screening-form.png)

### Hematology Bleeding Disorder Screening Form

A comprehensive pre-visit assessment form for screening potential bleeding disorders, including bruising patterns, family history, and menstrual bleeding evaluation.](/templates/hematology-bleeding-disorder-screening-form/)
[![Multiple Sclerosis Risk Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/multiple-sclerosis-risk-assessment-form.png)

### Multiple Sclerosis Risk Assessment Form

Comprehensive MS risk assessment questionnaire evaluating neurological symptoms, visual changes, fatigue levels, and offering convenient neurology consultation scheduling.](/templates/multiple-sclerosis-risk-assessment-form/)
[![Pelvic Organ Prolapse Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/pelvic-organ-prolapse-screening-questionnaire.png)

### Pelvic Organ Prolapse Screening Questionnaire

A comprehensive screening questionnaire to assess pelvic organ prolapse symptoms, severity levels, and quality of life impact to guide treatment recommendations and urogynecology consultations.](/templates/pelvic-organ-prolapse-screening-questionnaire/)
[![Pregnancy Symptom Checker](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/pregnancy-symptom-checker.png)

### Pregnancy Symptom Checker

A comprehensive pre-visit assessment form to track pregnancy symptoms, identify trimester-specific concerns, screen for high-risk factors, and flag emergency warning signs requiring immediate medical attention.](/templates/pregnancy-symptom-checker/)
[![Psoriatic Arthritis Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/psoriatic-arthritis-screening-questionnaire.png)

### Psoriatic Arthritis Screening Questionnaire

A comprehensive screening questionnaire for psoriasis patients experiencing joint pain, designed to assess symptoms, functional impact, and determine the need for rheumatology referral.](/templates/psoriatic-arthritis-screening-questionnaire/)
[![Raynaud's Phenomenon Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/raynauds-phenomenon-screening-questionnaire.png)

### Raynaud's Phenomenon Screening Questionnaire

A comprehensive screening tool for Raynaud's phenomenon that documents color changes, identifies triggers, assesses underlying conditions, and determines the need for rheumatology consultation.](/templates/raynauds-phenomenon-screening-questionnaire/)