Toxic Mold
Survivors

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for Victims of Toxic Mold

Mold Probability Report | ToxicMoldSurvivors.com
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1

Your Home

Environment

Location

Condition


2

Health Background

Context
This helps our analysis distinguish new symptoms from long-standing conditions.

3

Symptoms

Check all that apply
Check any symptom you currently experience or have experienced regularly. Checked items will reveal optional severity and duration fields.

Topical / Skin

General skin irritation / rashes
Fungal skin issues (ringworm, etc.)
Persistent dandruff
Jock itch (recurring)
Athlete’s foot (recurring)

Transitional Zones (Mucosal Boundaries)

Ear itch / infections
Nasal / sinus issues
Eye infections (recurring)
Excessive dental issues (decay, infections)
Thrush / oral yeast infections
Recurring sore throat
Vaginal infections (recurring)
Rectal irritation / itching

Head

Headaches / migraines
Blurred vision / pain behind eyes
Tinnitus (ringing in ears)
Unusual eye condition (e.g. keratoconus, uveitis)

Respiratory

Chronic cough
Shortness of breath / chest tightness
Asthma — new onset or worsening
Frequent respiratory infections / bronchitis
Reduced physical capacity / exercise tolerance

Neurological / Cognitive

Brain fog / difficulty concentrating
Short-term memory issues
Word retrieval problems (“tip of the tongue”)
Disorientation / feeling “not quite right”
Tremors / unusual muscle twitches
Seizures
Anxiety or depression — new onset or worsening

Fatigue / Energy

Chronic fatigue not relieved by sleep
Post-exertion crashes
Sleep disturbances (insomnia, unrefreshing sleep)

Inflammatory / Pain

Joint pain or stiffness
Muscle aches unexplained by activity
Sensitivity to light or sound

Digestive

Chronic bloating or gas
Nausea or appetite changes
IBS / irregular digestion
New or worsening food sensitivities

Immune / Systemic

Frequent infections (sinus, respiratory, urinary)
Slow wound healing
Unusual weight changes without dietary cause
New chemical or fragrance sensitivities
New or significantly worsened allergies

Glucose / Metabolic

Trouble with blood sugar control
Increased energy crash after meals
New diagnosis of diabetes or hypoglycemia
Pancreatic pain or digestive issues

Hormonal

Lab results showing abnormal hormone levels

4

Inspections & Testing

Professional

5

Self-Testing

Optional
Optional — but scored when provided

Petri Dish Air Testing

As described in Beat Toxic Mold on the Cheap. Providing results here significantly enhances your probability report. Leave blank if you haven’t tested.


6

In Your Own Words

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All content copyright LipidMagic/Toxic Mold Survivors/Lance Evans/Mediabook Press/Graphlink Media 2026. None of the information on this or related websites, or in any related content or books, is meant to diagnose, treat, cure or direct any healthcare decisions that conflict with those provided by your own healthcare team. Readers must understand that even “natural” products and remedies can be very strong. Care must always be taken. Working with experienced practitioners is always the best option.