Mold Quiz

1

Have you ever lived or worked in a building with visible water damage, leaks, or musty odors?* This field is required.Water Damage Exposure

Yes

No

2

Do you feel better when you’re away from your home (vacation, hotel, visiting family)?* This field is required.Improved Symptoms Away From Home

Yes

No

3

Do you experience chronic fatigue, brain fog, or difficulty concentrating without a clear cause?* This field is required.Chronic Fatigue or Brain Fog

Yes

No

4

Do you have ongoing sinus problems, allergies, or breathing issues that have not improved with treatment?* This field is required.Persistent Sinus or Respiratory Issues

Yes

No

5

Are you unusually sensitive to smells, perfumes, or chemicals?* This field is required.Sensitivity to Smells or Chemicals

Yes

No

6

Have you been exposed to damp basements, bathrooms, or poorly ventilated buildings for long periods?* This field is required.Regular Exposure to Damp Areas

Yes

No

7

Do you get headaches, dizziness, or feel worse when spending time inside your home?* This field is required.Regular Exposure to Damp Areas

Yes

No

8

Have you been diagnosed with MCAS, histamine intolerance, or unexplained inflammatory symptoms?* This field is required.Mast Cell or Histamine Issues

Yes

No

9

Do your symptoms (fatigue, coughing, sinus pressure, mood changes) get worse when you're indoors?* This field is required.Symptoms Worse Indoors

Yes

No

10

Have you taken antibiotics (especially Cipro or Levaquin) and felt significantly worse afterward?* This field is required.Reaction to Antibiotics

Yes

No

11

Are you looking for some guided help for your condition?* This field is required.

Yes

No

12

Name* This field is required.

First Name

Last Name

13

Where should we send your results to?* This field is required.

example@example.com

14

We will text you the results * This field is required.

Area Code

Phone Number

15

This is yours score out of 10