Looking for clues in Hives Name( this form is for new patients making office appointments): How long have your experienced hives or swelling ?   Less than six weeks    More than six weeks    This is not the first episode    I have borken out before with some medication  What time of day do the symptoms occur   Daytime    Nighttime    Both night and day  Is there a season of the year this occurs more commonly ?   No season    Spring    Summer    Fall    Winter  Please list EVERY medicaion, vitamin, herb, supplement that you take - every one. List any foods you think MIGHT be associated with hives Have you traveled outside the country in the last two years ? Have you experienced any of these symptoms:   Fatigue    Fever    wt gain    wt loss    Stress    Anxiety    Bruising skin    Hair loss    Tenderness over face    Sore throat  Which of these situations make you worse:   Rubbing and scratching    Swelling for tight clothing    Exposure to Sunlight    Exposure to cold temperatures    Exercise    Exposure to latex    Exposure to animals    Insect stings    Arts and crafts work  Have you experienced any of these symptoms?   Difficulty in  swallowing    Dental infection    Shortness of breath    Chronic cough    Wheezing    Nausea    Vomiting    Diarrhrea    Blood in stools    Coincidence with menstrual symptoms    Burning with urination    Muscle weakness    Joint swelling  Have you expereinced any of these infections ?   strep throat    cold sores    gum or dental infections    sexually transmitted infection    yeast infection    fungal or skin infections  Have you ever had a problem with your thyroid gland? Have you ever had a diagnosis of hepatitis? List any cancer or tumor you have had Do hives occur after sexual intercourse?

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