Allergy Injection Agreement Forms
PUSH provides allergy injection services for all eligible students who have a referral from their allergist. Prior to receiving allergy injections at PUSH, patients need to meet with their allergist and complete an allergy documentation packet which includes the forms listed below.
Allergy Injection Forms:
- Patient Allergy Service Agreement.
- Referring Allergist Agreement.
- Allergen Immunotherapy Order Form.
Forms and serum should be shipped to:
Purdue University Student Health Services
Allergy and Immunizations
601 Stadium Mall Drive
West Lafayette, IN 47907
We will only accept allergy serum shipped from a doctor's office. No hand delivered allergy serum will be accepted. We cannot accept deliveries on Saturdays, Sundays, holidays, or during any PUSH closure.
Patients will be notified by secure message when we receive their allergy serum. At that time you will be able to schedule your first appointment.