📋 Important: This form is designed for complex cases and works alongside your MC Scorecard and Lifestyle & Medical History intake forms. Please complete those first. This form covers areas those forms do not — pathogens, co-infections, mold/CIRS, MCAS, POTS, and heavy metal toxicity.
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Rate each symptom based on how often you experienced it over the last 90 days.
For Yes/No questions, select what applies. Scores update automatically — Yellow or Red flags an area for your consultation.
★ Hallmark items count double — they are the most clinically significant for that condition.
When finished, click 📋 Copy Score Summary and paste into an email to katka@katalysthealth.us, or click 🖨 Print / Save as PDF and attach the file.
Please note: Higher scores indicate a stronger pattern fit for discussion and possible follow-up — not a diagnosis. Many symptoms overlap across conditions. This form helps guide follow-up questions and testing priorities.
