Mold Questionnaire by Dr. Jill Crista

Mold Questionnaire by Dr. Jill Crista

Mold illness can cause a wide range of symptoms that are often misdiagnosed or overlooked. This comprehensive questionnaire, based on the work of leading mold illness experts, helps you assess whether mold exposure may be contributing to your health issues.

At Nourish Medical Center, we use this questionnaire as a screening tool to identify patients who may benefit from mold testing and treatment. This assessment helps you and your provider determine if mold illness should be investigated further.

You’ll Learn:

• Common symptoms and signs of mold exposure
• How to assess your risk of mold illness
• When to pursue mold testing and treatment

This handout includes a detailed questionnaire covering symptoms across multiple body systems (respiratory, neurological, immune, digestive, etc.), questions about your living and work environments, and a scoring system to assess your likelihood of mold-related illness. You’ll also learn about next steps if your score suggests mold may be an issue.

Who This Handout Is For:

• Individuals with unexplained chronic symptoms
• Anyone who has lived or worked in water-damaged buildings
• Patients with treatment-resistant health issues
• Those wanting to screen for possible mold illness

Download this handout to assess whether mold exposure may be affecting your health.