The Leeds Teaching Hospitals NHS Trust


If you are diagnosed with Spontaneous urticaria in our department you may be asked to fill in a symptom questionnaire to monitor your condition. We also use this information to determine whether your level of symptoms would qualify for other types of treatment recommended by national guidelines. You can download the form (right-click or long-press on mobile the link below) which is a PDF file and you can complete the form using any of the standard PDF softwares on your mobile or computer. You have to remember to save the form each time you fill it in. Once completed you can send it as an attachment to our department email address below with subject as "Urticaria Scoring Sheet FAO (the doctor/nurse/pharmacist who had reviewed you last)". If you have difficulties completing the form you could print and complete by hand. Once complete, take pictures of the form with your mobile or scan with computer and email them back as above.

Departmental email:

Urticaria Activity Scoring (UAS) Form

Dermatology Quality of Life Index (DQLI) Form