My Allergy Card Registration Form 18+
Thank you for registering to receive a My Allergy Card for 18+.

After you fill out the form, Allergy Life Australia will email you with a link and instructions on how to install your My Allergy Card.

This registration is for Adults 18+, if you are filling out this form for a child click here- https://mycard.allergylife.com.au/register

The details you fill out below are used for internal purposes only to set up and create your card, and are not shared publicly or to any third parties. We may use the registration information to validate details as required. For any questions, email contact@allergylife.com.au

Note: If you have multiple allergies, we may provide you with multiple My Allergy Cards based on the best practice for your circumstances (For example if you have Food and Environmental allergies, we may provide you with two My Allergy Cards)
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Your Name *
Your Email Address (for verification) *
What Australian State or Territory are you from? *
When were you born? (DD/MM/YY) *
What is your current occupation? (Student, Professional, etc)
What do you have from the below? *
Required
Please list your allergies/intolerances/conditions below (.i.e. Wheat Allergy, Tree Nut Allergy, Peanut Allergy, Shellfish Allergy, etc) *
What emergency instructions should be listed on your card? *
List emergency phone number (if part of emergency instruction)
Which colour would you like? *
What type of Smartphone device do you have? (This is for any technical queries)
How did you hear about the My Allergy Card?
Do you have any questions?
What happens after you submit? We will set up your card and email it to you within 5-15 business days. If you have any questions or queries email us at contact@allergylife.com.au
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