Have you ever lived in or renovated a home built before 1978? *

Yes

Do you work in or near industries involving chemicals, metals, or mining? *

Yes

Do you eat a lot of seafood, especially larger fish like tuna or swordfish? *

Yes

Have you been exposed to old dental fillings containing mercury (amalgam)? *

Yes

Do you live near busy roads, factories, or agricultural areas with pesticide use? *

Yes

Have you been exposed to prolonged chemical odors, such as cleaning products or paint fumes? *

Yes

Are you exposed to exhaust fumes, jet airplane exhaust, or gasoline fumes? *

Yes

Are you exposed to strong chemicals, pesticides, or industrial pollutants at work or home? *

Yes

Have you ever lived or worked in a building with visible mold or a musty smell? *

Yes

Do you have unexplained symptoms like sinus congestion, itchy eyes, or coughing? *

Yes

Do you feel worse in damp environments or after storms? *

Yes

Have you experienced skin rashes or unusual allergy-like symptoms? *

Yes

Are you unusually sensitive to tobacco smoke, perfumes, colognes, or other chemicals? *

Yes

Do you react negatively to disinfectants, cleaning products, or mothballs? *

Yes

Have you noticed symptoms worsening in fabric stores, grocery stores, or department stores? *

Yes

Do you frequently feel tired or experience chronic fatigue without an obvious cause? *

Yes

Have you noticed persistent digestive issues like bloating, diarrhea, or constipation? *

Yes

Have you had difficulty concentrating, memory loss, or brain fog? *

Yes

Have you taken prolonged courses of antibiotics, steroids, or oral contraceptives? *

Yes

Do you experience recurring yeast infections, urinary tract infections, or fungal infections? *

Yes

Does your skin itch, tingle, burn, or develop unexplained rashes? *

Yes

Do you crave sugar or experience symptoms that worsen after consuming sugary foods? *

Yes

Do you have a history of autoimmune or chronic illnesses? *

Yes

First Name *

Last Name *

Email *

Phone *

I understand this quiz is an educational screening tool, not a medical diagnosis, and that completing it does not create a provider–patient relationship.

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