Are Your Symptoms Caused By Toxic Mold? A Mold Questionnaire

Do you have symptoms of mold sickness?

If you experience strange symptoms – like those found in fibromyalgia and chronic fatigue syndrome – you may be suffering from mold sickness.

To find out if you have symptoms of mold sickness you can take the questionnaire below. It is the initial screening form I use to help diagnose toxic mold illness. It was devised by Dr. Ritchie Shoemaker – the world’s leading expert on mold toxicity, mold illness, and a condition known as Chronic Inflammatory Response Syndrome (CIRS).

When you’re going through the questionnaire, please ensure you answer the questions in numerical order. Don’t skip ahead to other sections.

Now, let’s find out if you have symptoms of mold sickness!

Step 1: Mold exposure 

This section is an environmental exposure survey. It will determine whether (or not) you have ever been exposed to an environment that might lead to mold sickness. Please answer each of the following questions.

Mold exposure

• • 1) Have you been exposed to the interior of a water-damaged building and/or microbial growth? 

    Yes (If yes, please answer the next three questions)

    No

    Maybe

• • •   1a) Do you have samples/evidence of spore or genus and species of fungus (air test, ERMI test, etc.)?

      Yes

      No

      Maybe

• • •  1b) Is there visible microbial growth (mold)?

      Yes

      No

      Maybe

• • •  1c) Is there a musty smell?

      Yes

      No

      Maybe

Insect bites

• •  2) Do you remember a tick bite occurring before your illness began? 

    Yes (If yes, please answer the next two questions)

    No

    Maybe

• • •  2a) Did you have an unexplained rash after the bite?

      Yes

      No

      Maybe

• • • 2b) Did you experience flu-like illness after the bite?

      Yes

      No

      Maybe

• •  3) Have you had a brown recluse or another poisonous spider bite? 

    Yes (If yes, please answer the next question)

    No

    Maybe

• • •  3a) Did you experience flu-like illness after the bite?

      Yes

      No

      Maybe

Other possible causes

• •  4) Did you become ill after eating fish?

    Yes

    No

    Maybe

• •  5) Did you become ill after exposure to a body of fresh water?

    Yes

    No

    Maybe

• •  6) Did you become ill after exposure to the ocean during a “red tide” or other algae bloom?

    Yes

    No

    Maybe

• •  7) Did you become ill after exposure to an estuary fish kill?

    Yes

    No

    Maybe

• •  8) Did you become ill after exposure to a closed shellfish bed area?

    Yes

    No

    Maybe

Now take a look at your responses. If you answered:

• Yes to any of the above questions, please mark this section as positive.
• No to all of the above questions, please mark this section as negative.
• Maybe to any of the above questions, please mark this section as indeterminate.

Step 1 results:

Positive
Negative
Indeterminate 

Step 2: Symptoms of mold sickness cluster questionnaire

Toxic mold creates a group of symptoms that are rather unique. This second section is used to see if the symptoms you’re experiencing are symptoms of mold sickness.

You’ll notice that some questions list multiple symptoms. You do not need to have every symptom for each question to mark it as positive. Mark the question positive if you have one (or more) of the symptoms. If you do not experience any of the symptoms listed for a given question, please mark that question negative.

1. Fatigue/weakness

Positive
Negative

2. Headache

Positive
Negative

3. Aches, cramps

Positive
Negative

4. Unusual sharp, clawing, electrical or ice-pick pain(s)

Positive
Negative

5. Light sensitivity; red eyes; blurring, tearing

Positive
Negative

6. Shortness of breath; cough; sinus issues

Positive
Negative

7. Abdominal pain, secretory diarrhea; bile acid reflux

Positive
Negative

8. Joint pain; morning stiffness

Positive
Negative

9. Issues with memory, concentration, word assimilation, confusion, disorientation

Positive
Negative

10. Mood swings; appetite swings; sweats; challenges with temperature regulation (hypothalamic functioning)

Positive
Negative

11. Thirst; frequent urination; static shocks

Positive
Negative

12. Numbness, tingling, taste abnormalities

Positive
Negative

13. Vertigo; tremors; skin sensitivity to light touch

Positive
Negative

Please add up how many times you chose ‘positive’. Your score is:

Positive: If you have eight or more positives

Negative: If you have seven positives or less

Step 2 results:

Positive
Negative

If your results for both step one and step two were negative, you do not need to complete this third step. Your symptoms are likely not caused by toxic mold.

If you scored positive for any or all of the previous steps, please continue with this third step.

Step 3: VCS testing for mold sickness

VCS stands for visual contrast sensitivity. This is not a vision test. It does not test your eyes. It tests your brain. This test measures your brain’s ability to detect different contrasts. Contrast is your ability to discern black from white, and also between different shades of gray.

Toxic mold decreases blood flow to your optic nerve, a phenomenon called peripheral hypoprofusion. When mold toxicity affects your optic nerve, it is difficult to notice changes in contrast.

Please note that this is a screening tool and does not diagnose toxic mold. However, it is 92% accurate, meaning that 92% of those who failed the VCS test had mold toxicity or CIRS (Chronic Inflammatory Response Syndrome). (1, 2)

To perform a VCS test, please visit Dr. Shoemaker’s website. The cost to perform this test is $15usd. You can also do the test for free at this website (although I find it less accurate).

Do YOU have symptoms of mold sickness? 

If you test positive in all three sections (Exposure, Symptoms, and VCS) there is a 95% likelihood that you have mold sickness and/or CIRS.

If this is you, contact us today to schedule a free 15 minute phone chat with our certified mold sickness practitioner.

I want to be crystal clear that these 3 steps are only a screening tool and are not a diagnosis. Even if you test positive in all three sections, it does not confirm that you have symptoms of mold sickness. Instead, it shows that it is highly likely that mold is making you sick. Further laboratory testing will be required to accurately assess and diagnose your condition.

If you test negative in any of these sections, it is less likely that you are suffering from mold toxicity or CIRS. However it does not rule it out completely. But it does warrant an investigation into your health issues outside the context of mold/mycotoxin illness.

What to do if you’re suffering from toxic mold sickness

If you suspect you have mold illness or CIRS after completing the three steps outlined in this post, you need to immediately remove yourself from the source of mold. Have your home and workplace tested to ensure there is no mold growth. Then, look to find a Shoemaker-trained practitioner to help guide you out of mold toxicity symptoms and back to health.

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Flourish Clinic has a Shoemaker certified practitioner – contact us today to book a free 15 minute consultation.

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If mold is making you sick, the gold standard for treatment is a protocol developed by Dr. Ritchie Shoemaker. He has done extensive scientific research into mold illness (also known as CIRS) and has trained other practitioners in the Shoemaker Protocol.

If you do test positive all three sections, you need to find a mold-literate practitioner to confirm a diagnosis of CIRS and/or mold toxicity. Do not expect your family physician to be well versed in toxic mold.

Flourish Clinic’s Mark Volmer is a certified Shoemaker Protocol practitioner – contact us today to book a free 15 minute chat!

Many mold-literate practitioners will be able to work with you via skype/zoom consults. You do not have to be living in their place of residence in order to become a patient under their care.

Want to learn more about fatigue and mold?

Now, I want to hear from you!

What did this 3-step screening reveal regarding your health?

Share your answers in the comments section below!