Lyme's Disease Questionnaire

Lyme's Disease Questionnaire

Answer all questions honestly for best results. You will recieve an email with your score upon completion.
Please provide your contact details for more information.

By completing the quiz and inputting your information below, you consent to having your information shared with Recreated Health. You will also opt-in to our email list. This tool does not provide medical advice It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Section 1: Symptom Frequency

We invite you to rate the frequency of each symptom you experience, providing a comprehensive tool to track and discuss your symptoms.
I am experiencing unexplained fevers, sweats, chills, or flushing*
I am experiencing unexplained weight change; loss or gain*
I am experiencing fatigue, tiredness *
I am experiencing unexplained hair loss*
I am experiencing swollen glands*
I am experiencing sore throat*
I am experiencing testicular or pelvic pain*
I am experiencing unexplained menstrual irregulation*
I am experiencing unexplained breast milk production; breast pain*
I am experiencing sexual dysfunction or loss of libido*
I am experiencing irritable bladder or bladder dysfunction*
I am experiencing upset stomach*
I am experiencing change in bowel function (constipation or diarrhea)*
I am experiencing chest pain or rib soreness*
I am experiencing shortness of breath or cough*
I am experiencing heart palpitations, pulse skips, heart block *
I have a history of heart murmur or valve prolapse *
I am experiencing joint pain or swelling *
I am experiencing stiffness of the neck or back *
I am experiencing muscle pain or cramps *
I am experiencing headaches *
I am experiencing neck cracks or neck stiffness *
I am experiencing tingling, numbness, burning, or stabbing sensations *
I am experiencing facial paralysis (Bell's palsy) *
I am experiencing eyes/vision: double, and/or blurry *
I am experiencing ears/hearing: buzzing, ringing, ear pain *
I am experiencing increased motion sickness, vertigo *
I am experiencing light-headedness, poor balance, difficulty walking *
I am experiencing tremors*
I am experiencing confusion, difficulty thinking*
I am experiencing difficulty with concentration or reading*
I am experiencing forgetfulness, poor short-term memory*
I am experiencing disorientation: getting lost; going to wrong places*
I am experiencing difficulty with speech or writing*
I am experiencing mood swing, irritability, depression*
I am experiencing disturbed sleep: too much, too little, early awakening*
I am experiencing exaggerated symptoms or worse hangover from alcohol*

Section 2: Most Common Lyme Symptoms

This section is designed to help you assess the frequency of common Lyme disease symptoms you may be experiencing.
I am experiencing fatigue*
I am experiencing forgetfulness*
I am experiencing joint pain or swelling*
I am experiencing tingling, numbness, burning, or stabbing sensations*
I am experiencing disturbed sleep: too much, too little, early awakenings*

Section 3: Lyme Incidence

This section is designed to help you assess your historical Lyme incidence.
I have had a tick bite with no rash or flu-like symptoms*
I have had a tick bite, bull's eye rash/undefined rash, followed by flu-like symptoms*
I live in what is considered a Lyme-endemic area. Not sure? Copy/paste this url to your browser here: https://www.cdc.gov/lyme/datasurveillance/lyme-disease-maps.html*
I have a family member diagnosed with Lyme and/or other tick-borne infections*
I experience migratory muscle pain*
I experience migratory muscle pain*
I experience migratory joint pain*
I experience experience tingling/burning/numbness that migrates/comes and goes*
I have received a prior diagnosis of chronic fatigue syndrome or fibromyalgia*
I have received a prior diagnosis of a specific autoimmune disorder (lupus, MS, or rheumatoid arthritis), or of a non-specific autoimmune disorder*
I have had a positive Lyme test (IFA, ELISA, Western Blot, PCR, and/or Borrelia culture)*

Section 4: Overall Health Score

This section allows you to evaluate various aspects of your well-being and track any changes in your physical, mental, and emotional health over time, providing valuable insights.
Thinking about my overall physical health, in the past 30 days, how many days was my physical health not good*
Thinking about my overall mental health, in the past 30 days, how many days was my mental health not good*

My Answer Score
Results
If you scored 46 or more

You have a high probability of a tick-borne disorder and should see a Certified Lyme Specialist for further evaluation.
If you scored between 21 and 45

You possibly have a high probability of a tick-borne disorder and should see a Certified Lyme Specialist for further evaluation.
If you scored under 21

You're not likely to have a tick-borne disorder.
Should be Empty:

Lyme's Disease Questionnaire

Please provide your contact details for more information.

Section 1: Symptom Frequency

Section 2: Most Common Lyme Symptoms

Section 3: Lyme Incidence

Section 4: Overall Health Score

Results

If you scored 46 or more

If you scored between 21 and 45

If you scored under 21