Crista Mold Questionnaire

Directions

  • Download the Crista Mold Questionnaire

    • Click the button below.

    • Click the download arrow in the top, right corner of the page. (Highlighted in the photo to the right.)

  • Fill out the questionnaire

    1. Check the symptoms that have affected you in the last 3-6 months.

    2. For each category (1-3), record the total number of boxes checked.

    3. Determine your score for each category (1-3) using the guide on the questionnaire.

    4. Record your score for each category (1-3) in the Total Mold Risks section.

    5. The sum of all 3 category scores equals your Total Mold Risk.

  • Save your completed questionnaire by clicking File > Save.

  • Send us your completed questionnaire.

    • Option 1: Login to P2P, message Michelle Kosvitch, and attach your questionnaire

    • Option 2: Attach your questionnaire to an email and send it to info@philly-im.com. (Our email is HIPAA compliant.)