Symptom Checklist

As Seen On...
  • This is a questionnaire to determine the probability of your having Lyme disease and other tick borne disorders.

    Think about how you have been feeling over the previous month and how often you have been bothered by the following:

  • Section 1

    Enter numbers only:
    0 - Never
    1 - Sometimes
    2 - Almost all the time
    3 - All of the time
  • Section 2

  • Section 3

  • Lastly, check the box below if on Section 1 you rated a ‘3’ for ALL of the following:

    • Fatigue
    • Forgetfulness, poor short term memory
    • Joint pain or Swelling
    • Tingling, numbness, burning or stabbing sensations
    • Disturbed sleep – Too Much, Too Little, Early Awake
  • Now please take your final score and compare it to the scale used by Dr. Horowitz
    • 0 – 20 Tick Borne Illness not likely
    • 21-45 Tick Borne Illness possible
    • 46 and above Tick Borne Illness highly likely