Web Site Is Your Home Making You Sick? This free online test is designed to give you deeper insight to how your environment can affect your health. We offer at no additional fee the ability to speak with one of our expert analysts to review the results of your environmental health screen. Our goal is to ensure that all your questions and concerns are answered. We can also help by providing you with resources related to medical, legal, and environmental issues. Click the “get started button” to find out if your home or place of work is affecting your health. This is in no way a medical diagnostic test but is meant to give you a better understanding of the health risks your environment can present. For specific health information we suggest consulting your physician. Have you experienced any of these symptoms? Symptoms1 Headaches Eye Irritation Sneezing Symptoms2 Itching Memory Loss Blurred Vision Symptoms3 Ear Infections Chronic Sinusitis Nose Bleeds Have you experienced any of these symptoms? Symptoms4 Coughing Chronic Bronchitis Asthma Symptoms5 Nausea Diarrhea Heart Palpitations Symptoms6 Weight Loss/Weight Gain Chronic Fatigue Sexual Dysfunction Have you been diagnosed with any of these ailments? Symptoms7 Fibromyalgia Rheumatoid Arthritis Inflammation Symptoms8 Lupus Hypersensitivity Pneumonitis Cancer Symptoms9 COPD Lyme Disease Histoplasmosis Have you had any water leaks in your home or place of work in the last 6 months? Yes No Do you see any water staining on walls or ceiling in your home or place of work? Yes No Can you see visible mold growing on the wall, ceiling, or floors? Yes No Have you noticed any musty or mildew smells in your home or place of work? Yes No Do you have an HVAC system? Yes No Thank you for taking our free online screen. Please fill out the form below to receive your Results. After receiving your results, within 24 – 48 hours our expert analysts will reach out to help answer any questions about possible environmental risk factors at no additional fee. First Name * Last Name * Email * State * AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Phone * Best Time To Call select a time Anytime 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM Order Number Is Your Home Making You Sick? This free online test is designed to give you deeper insight to how your environment can affect your health. We offer at no additional fee the ability to speak with one of our expert analysts to review the results of your environmental health screen. Our goal is to ensure that all your questions and concerns are answered. We can also help by providing you with resources related to medical, legal, and environmental issues. Click the “get started button” to find out if your home or place of work is affecting your health. This is in no way a medical diagnostic test but is meant to give you a better understanding of the health risks your environment can present. For specific health information we suggest consulting your physician. Have you experienced any of these symptoms? Symptoms1 Headaches Eye Irritation Sneezing Symptoms2 Itching Memory Loss Blurred Vision Symptoms3 Ear Infections Chronic Sinusitis Nose Bleeds Have you experienced any of these symptoms? Symptoms4 Coughing Chronic Bronchitis Asthma Symptoms5 Nausea Diarrhea Heart Palpitations Symptoms6 Weight Loss/Weight Gain Chronic Fatigue Sexual Dysfunction Have you been diagnosed with any of these ailments? Symptoms7 Fibromyalgia Rheumatoid Arthritis Inflammation Symptoms8 Lupus Hypersensitivity Pneumonitis Cancer Symptoms9 COPD Lyme Disease Histoplasmosis Have you had any water leaks in your home or place of work in the last 6 months? Yes No Do you see any water staining on walls or ceiling in your home or place of work? Yes No Can you see visible mold growing on the wall, ceiling, or floors? Yes No Have you noticed any musty or mildew smells in your home or place of work? Yes No Do you have an HVAC system? Yes No Thank you for taking our free online screen. Please fill out the form below to receive your Results. After receiving your results, within 24 – 48 hours our expert analysts will reach out to help answer any questions about possible environmental risk factors at no additional fee. First Name * Last Name * Email * State * AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Phone * Best Time To Call select a time Anytime 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM
