MoldCo | Mold Toxicity Assessment

1
What brings you to MoldCo today?* This field is required.
I’m not getting answers and suspect toxic mold exposure
I’ve been diagnosed and need help recovering
I’ve moved but still feel sick
I want testing to get clarity on my symptoms
I have symptoms but haven't found relief
I'm looking to change my current mold treatment care plan
Other
2
To start, what's your name?* This field is required.We're glad you're here.
First Name
Last Name
3
Where can we email you?* This field is required.We’ll also send expert tips and guidance on healing from Mold Toxicity.
email@email.com
4
What's your phone number?* This field is required.We only text you with important info or scheduling help if you choose to work with us, and we'll never spam.
Please enter a valid phone number.
5
Where are you located?* This field is required.We offer specialized lab testing nationwide, and we are actively treating patients in select states. Please provide your state so we can curate your offering.
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
6
Have you ever lived or worked in a place that may have had mold?* This field is required.Mold can hide behind walls or in HVAC systems and is commonly identified by a musty, damp, or earthy smell.
Yes - A water-damaged building in your home or workplace
Yes - Visible mold indoors in your home or workplace
Yes - Noticing musty, damp, or earthy smells in your home or workplace
Not sure
No
7
You're in the right place.Our protocol and labs are built on 30+ years of clinical experience and 30,000+ patients. We are guided by Dr. Shoemaker, our Founding Physician, and Dr. Scott McMahon, our Medical Director, both pioneers in Mold Toxicity.
8
How did you hear about MoldCo?* This field is required.
Google search
Facebook or Instagram ad
Reddit
Doctor or coach referral
Podcast
Mold inspector or remediator
Another patient
Content creator
Other
9
Optional: Did someone refer you to us?
10
Messaging opt-inWe use SMS to keep you updated on your waitlist status.
By checking this box, I agree to receive marketing text messages and phone calls regarding products, waitlist status and other promotional events at the phone number provided above to MoldCo. Message & data rates may apply. Reply HELP for more information, STOP to cancel at any time, and START if you would like to resume.
I agree to receive customer text messages as needed for the orders that I have placed at the phone number provided above to MoldCo. Message & data rates may apply. Reply HELP for more information, STOP to cancel at any time, and START if you would like to resume.
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